Whipple’s Operation without an Operative Mortality in 37 Consecutive Patients: Thai Surgeons’ Experiences
Wiroon Boonnuch, MD*, Thawatchai Akaraviputh, MD*, Darin Lohsiriwat, MD*
Affiliation : * Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Objective : Pancreaticoduodenectomy (Whipple’s operation) represents a considerable surgical challenge.
The operative mortality rate after Whipple’s operation is still less than 5%. Recent studies show
pancreaticojejunostomy (PJ) anastomosis is the “Achilles heel” of the procedure. The authors present the
results of Whipple’s operation without mortality which were performed in the Division of General Surgery,
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Materials and Methods : From January 1991 to December 2003, thirty-seven consecutive patients who underwent
Whipple’s operation were enrolled in the present study. The ages ranged from 33 to 79 years (mean 57.13).
There were 19 male and 18 female patients. Twenty-nine of them underwent a pylorus preserving
pancreaticoduodenctomy (PPPD). Construction of the PJ anastomosis was mostly performed by a dunking
technique, that is, the invagination of the pancreatic resected end into the jejunum.
Results : There was no postoperative mortality from anastomotic leakage. Surgical wound infections occurred
in 7 patients, gastric atony in 2 patients, and PJ anastomosis leakage which created a fistula in 1 patient. All
37 patients were discharged in an improved condition following surgery. The median follow-up was 2 years
(range: 4 month-11 years). Eighteen patients died from liver failure. Until now 19 patients are doing well.
Conclusion : The authors demonstrated that the dunking technique used for PJ anastomosis in Whipple’s
operation provided a good result without any mortality rate.
Keywords : Whipple’s operation, Dunking technique
