March 1997

Invited Commentary

Author Affiliations

Loyola University of Chicago Stritch School of Medicine Maywood, Ill

Arch Surg. 1997;132(3):299. doi:10.1001/archsurg.1997.01430270085017

In the 61 years since the first publication by Whipple et al1 concerning pancreatoduodenectomy, there have been numerous modifications to his technique. Although pancreaticogastrostomy was first described as a technical feasibility in 1934,2 it was not until 1946 that it was applied clinically. That report, by Waugh and Clagett, 3 was of one case. During the 1950s and 1960s, similar reports of 1, 2, and 3 cases at a time were performed. More recent series have been larger. The unifying theme of these reports has been of minimal anastomotic leakage and correspondingly minimal morbidity and mortality. There are now more than 300 such cases reported in the international literature. Leakage, as reported in aggregate, is approximately 2%. For the most part, the pancreaticogastrostomy has been used because of that fact. Pikarsky et al, in this article, emphasize instead the lack of major morbidity in the 28 patients they

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