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Invited Critique
Jan 2012

The Right Way to Do a Whipple ProcedureComment on “Stenting and the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy”

Author Affiliations

Author Affiliation: Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.

Arch Surg. 2012;147(1):41. doi:10.1001/archsurg.2011.1016

One of our recent hepatobiliary-pancreatic surgery fellows made rounds on his first day of fellowship and asked me afterward why we did not have a standard way of treating patients who had undergone Whipple procedures. During rounds he saw 4 such postoperative patients, all of whom had undergone resection 2 days earlier. Two had nasogastric tubes, 3 had intra-abdominal drains, 2 had external pancreatic duct stents, 1 had an internal pancreatic duct stent, and 1 had neither drains nor stents at all. The fellow quickly surmised that there were as many variations as there are attending pancreatic surgeons on our faculty, and he made several (unsuccessful) attempts to get us to standardize our approach.

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