Pylorus-preserving pancreaticoduodenectomy

Surgical procedures to resect periampullary malignancies and benign processes have evolved over the last 100 years since Halsted from the Johns Hopkins Hospital reported the first successful resection of a periampullary cancer in 1899 [1]. He described a local ampullary resection with reanastomosis of the pancreatic and bile ducts into the duodenum for a woman who presented with obstructive jaundice. Codivilla is often credited with performing the first en bloc resection of the head of the pancreas along with the duodenum for periampullary carcinoma, but unfortunately, the patient did not survive the postoperative period [2]. The first successful two-stage pancreaticoduodenectomy (PD) was performed by Kausch in 1909 [3]. In 1914, Hirschel reported the first successful onstage PD [4]. In the first third of the 20th century, most periampullary cancers that were operated on were managed by a transduodenal approach similar to that reported by Halsted. PD was not often considered as a viable option until 1935, with the report of Whipple and colleagues of three, two-stage, en bloc resections of the head of the pancreas and duodenum [5]. Over the next decade, several modifications and technical refinements were made in the operation. The procedure was rarely performed until the 1980s because of the high operative morbidity, mortality, and poor prognosis associated with periampullary malignancies. During the last three decades there have been significant advances in terms of our ability to diagnose and care for the family of diseases treated with PD, as well as an increased understanding of their pathogeneses.