title: Whipple's operation without an operative mortality in 37 consecutive patients: Thai surgeons' experiences.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  The authors demonstrated that the dunking technique used for PJ anastomosis in Whipple's operation provided a good result without any mortality rate.
authors.affiliation: Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand.
authors.forename: Wiroon
authors.initials: W
authors.lastname: Boonnuch
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.forename: Darin
authors.initials: D
authors.lastname: Lohsiriwat
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D013785:Thailand; D016896:Treatment Outcome