Evolution of the Whipple procedure at the Massachusetts General Hospital

Carlos Fernández-Del Castillo, Vicente Morales-Oyarvide, Deborah McGrath, Jennifer A. Wargo, Cristina R. Ferrone, Sarah P. Thayer, Keith D. Lillemoe, Andrew L. Warshaw

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


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%). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)S56-S63
JournalSurgery (United States)
Issue number3 SUPPL.
StatePublished - Sep 2012

ASJC Scopus subject areas

  • Surgery

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