title: Evolution of the Whipple procedure at the Massachusetts General Hospital.
abstract: BACKGROUND
  Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH).
  
  
  METHODS
  We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded.
  
  
  RESULTS
  The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%).
  
  
  CONCLUSIONS
  The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving.
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. cfernandez@partners.org
authors: Carlos
authors: C
authors: Fernández-del Castillo
authors: Vicente
authors: V
authors: Morales-Oyarvide
authors: Deborah
authors: D
authors: McGrath
authors: Jennifer A
authors: JA
authors: Wargo
authors: Cristina R
authors: CR
authors: Ferrone
authors: Sarah P
authors: SP
authors: Thayer
authors: Keith D
authors: KD
authors: Lillemoe
authors: Andrew L
authors: AL
authors: Warshaw
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000266:history / Q000601:surgery; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D010190:Pancreatic Neoplasms / Q000266:history / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000266:history*