Pancreaticoduodenectomy: a developing country perspective

Objective: To review retrospectively, the results of Whipple's procedure from 1986 to December 2009 at the Aga Khan University Hospital. Methods: Patient's case notes were reviewed to extract information related to demographics, clinical and laboratory data, operative procedure and post operative period. Surgical mortality was defined as death within 30 days of procedure. Results: Hundred and twenty one patients underwent a successful pancreaticoduodenectomy during this period. There were 78 males and 43 females. Most presented with clinical features of obstructive jaundice. Perioperative evaluation in the majority included an abdominal ultrasound and contrast enhanced CT scan. A preoperative ERCP was performed in 64 (53%) patients and a stent was placed in 32 (26%). Stent related sepsis was noted in 8 patients (25 %). Eighty four (69%) patients underwent a standard resection, 31% had a pylorus preserving procedure. The commonest pathology was adenocarcinoma located in the pancreatic head or periampullary area. Post operative morbidity was noted in 54% of patients, the commonest being chest infection (20%) followed by delayed gastric emptying and pancreatic anastomotic leak. There were 12 perioperative deaths giving a surgical mortality of 10%. Conclusion: To our understanding this is the largest series of consecutive pancreaticoduodenectomies reported in Pakistan. Our morbidity and mortality rates compare favourably with international centers of similar yearly case volume. There is a need to establish regional centers to effectively manage complex disease conditions and improve the standard of care offered to our patients. (author)