God placed pancreas at the back (in the retroperitoneum) so that surgeons don’t mess with it…. The surgery of the pancreas really took off in the late 19th century.With the surgery came the technical challenges of improving survival and reducing morbidity and mortality. It is due to these pioneering and daring surgery that in 2012 the mortality from resection of head of Pancreas has come down to 1%
Till my residency in Surgery in 2003, Whipple’s pancreatectomy was a phrase often spoken with excitement and in hushed tones. No resident knew what it really was because you saw a very few cases Things have changed for me over the last 8 years and I am sure the surgery doesnt bring about the same awe it used to have.
Early beliefs
The earliest misconception was Duodenum is essential for life. Desjardin(1907) and Sauve (1908) dispelled that notion. Dragsted (1918) performed total duodenectomy in dogs and showed survival. Another point of worry for the surgeons was What to do with the pancreatic Stump? As late as 1935 Whipple thought that Pancreaticojejunal anastomoses would lead to dissolution of the intestine by the pancreatic enzymes. Initial attempts at ligation of the pancreatic duct met with failures and patients has pancreatic leaks, sepsis and death.
Back in 1909 Coffey and Kehr suggested that Pancreas could be implanted into jejunum. Hunt in 1941 showed that Pancreaticojejunostomy was safe and viable option.
Early attempts at diversion of bile through cholecystojejunostomy was also met with a higher incidence of ascending cholangitis and Whipple showed that Choledochojejunostomy was far better than cholecystojejunostomy
Initially there was a higher risk of marginal ulcerations which subsided somewhat when resection of antrum was complete and gastrojejunostomy was done far away from pancreaticojejunostomy.


