PURPOSE: To review the current standards of pancreaticoduodectomies and show that excellent results can be achieved by a single surgeon.
METHODS: A case series of consecutive patients, operated on during the period March 1999 to February 2003, were retrospectively evaluated. The patients’ medical records were abstracted for demographic data, clinical presentation, operative indication, operative time, amount of transfusion, perioperative morbidity, mortality and other operative records.
RESULTS: The average age was 57.5 years, ranging from 35 to 78. Jaundice was the main presenting symptom (68.3%) and preoperative PTBD was performed at 34 cases (56.7%). The most common indication for this procedure was cancer of the ampulla of Vater (28 cases, 47.3%) and the second was pancreatic head cancer (14 cases, 23.6%). A total of 60 patients underwent a pancreaticoduodectomy during the 4 year period. Fifty-three patients underwent a pylorus- preserving pancreaticoduodectomy (PPPD) and 5 a classical Whipple procedure. The operation lasted an average of 367 minutes, ranging from 250 to 555. The mean operative blood loss was 750 ml, ranging from 180 to 2400. About seventy- two percent of patients had no major complications, 28% had one or two more major complications and there was only one operative mortality (1.7%). The major morbidity was leakage of the pancreaticojejunostomy (5 cases, 8.3%). Delayed gastric emptying occurred in 6 patients.
CONCLUSION: The above study demonstrates that a complicated procedure, such as the Whipple pancreaticoduodectomy, can be performed with excellent results by a single surgeon with sufficient experience. The most important prerequisite is that the surgeon be adequately trained in the procedure. In low-volume hospitals, the case load should be restricted to a minimal number of trained surgeons in order to concentrate the experience.
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