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. 2023 Sep;1(2):e100014.
doi: 10.1136/egastro-2023-100014. Epub 2023 Oct 27.

Revolutionary transformation lowering the mortality of pancreaticoduodenectomy: a historical review

Bo Chang Wu  1   2 , Jakub Wlodarczyk  1   3 , Sanaz Nourmohammadi Abadchi  1 , Niloufar Shababi  1 , John L Cameron  1 , John W Harmon  1
Affiliations

Revolutionary transformation lowering the mortality of pancreaticoduodenectomy: a historical review

Bo Chang Wu et al. eGastroenterology. 2023 Sep.

Abstract

The History Maker paper focuses on the extraordinary revolution that dramatically improved the surgical results for the Whipple procedure (pancreaticoduodenectomy) in the 1980s and identifies Dr. Cameron as the leader of this revolution, who reported a mortality rate of approximately 1%. The revolutionary reduction of postoperative mortality for the Whipple procedure was achieved by adherence to gentle and precise Halstedian surgical techniques with adequate drainage of pancreatico-jejunal anastomosis with closed-suction silastic drains, along with the development of high-volume surgeons and hospitals. Excellent teamwork in patient care, including but not limited to preoperative evaluation by multidisciplinary teams, intraoperative communication between surgeons and anaesthesiologists, and postoperative management, contributed to a successful Whipple procedure.

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Conflict of interest statement

Competing interests JWH is the Editor-in-Chief of eGastroenterology.

Figures

Figure 1
Figure 1. Illustration of the reconstruction before and after the Whipple procedure, pancreaticojejunostomy, choledochojejunostomy and gastrojejunostomy. (Permission of reprint obtained (online supplemental file 1)).
Figure 2
Figure 2. Representing mortality rate after Whipple procedure over decades from 1950 to 2010. Data based on various references providing mortality rate after Whipple procedures performed in US hospitals from specific decades. In case of multiple data presenting specific decade mean value was provided. (References: 1950–1960s, 1970s, 1980s, 1990s and 2000s7).
Figure 3
Figure 3. Careful dissection and gentle tissue handling during Whipple procedure. (Permission of reprint obtained (online supplemental file 1)).
Figure 4
Figure 4. Placement of closed-suction drains at the pancreatico-jejunal anastomosis (Permission of reprint obtained (online supplemental file 1)).
Figure 5
Figure 5. Representing surgical-related death after Whipple procedure over time. Data recorded from Whipple procedures performed in Massachusetts General Hospital (Boston, Massachusetts, USA) between 1941 and 2011. n—number of postoperative deaths after Whipple procedure. (Permission of reprint obtained).
See this image and copyright information in PMC

References

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