Perioperative Outcomes of Pancreaticoduodenectomy: Nepalese Experience Paleswan Joshi Lakhey • Ramesh Singh Bhandari • Bikal Ghimire • Mahesh Khakurel Published online: 2 June 2010 Ó Socie ´te ´ Internationale de Chirurgie 2010 Abstract Background Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with sub- stantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital. Patients and methods A retrospective review of medical records of patients who underwent PD from April 2005 through May 2009 was done. Perioperative morbidity was defined according to the standard of the International Study Group for Pancreatic Fistula (ISGPF). The patient demo- graphics, type of surgery, and perioperative morbidity and mortality were evaluated. The factors associated with increased morbidity were analyzed. Results Twenty-four patients underwent PD, and there were no perioperative deaths. The overall morbidity was 58%, with a pancreatic fistula rate of 13%. None of the associated parameters, like increasing age, the presence of co-morbidity, preoperative biliary drainage, and duration of surgery, were found to increase the morbidity. These results of PD, though a small case series, are comparable to the international standard. Better outcomes can be achieved even in low- to medium-volume centers in developing countries where a dedicated team with special interest in pancreatic surgery is in place. Conclusions Although there were no deaths after PD in our series, the morbidity was higher than that observed in other high-volume centers. To decrease the morbidity associated with PD, various factors must be streamlined, among them, the operative technique and the intensive perioperative management of the patient, as well as uni- form definition of complications, use of a multidisciplinary approach, and identification of associated risk factors. Introduction An American surgeon, William Halsted, performed the first successful local resection of periampullary tumor in 1898. After resecting the segment of the second part of the duodenum, including the tumor, he performed end-to-end anastomosis of the duodenum and reimplanted the bile duct and the pancreatic duct [1]. It was Walther Kausch, a German surgeon from Berlin, who successfully performed regional resection of a periampullary tumor in 1909 and reported in 1912 [2]. However, the regional resection was popularized by Allen O. Whipple in an article published in 1935 [3]. Initially the procedure was performed in two stages. It became widely known after the publication but was infrequently performed. Until 1980, the operative mortality of PD was 25%. Because of this high mortality rate as compared to other elective operations, surgeons proposed abandoning the procedure as treatment for car- cinoma of the head of the pancreas [4]. In the 1990s, however, as experience in performing PD increased, large- volume centers of excellence developed, substantially decreasing the mortality rate to below 5% [5, 6]. However, in low-volume centers, it was still high, in the range of 13–20% [7, 8]. The morbidity related to PD is still high, even in high-volume centers, although there has been improvement in the management of complications [9]. The present study is intended to assess the perioperative outcomes of PD performed in a medium-volume center in a developing country with limited resources to generate P. J. Lakhey (&) Á R. S. Bhandari Á B. Ghimire Á M. Khakurel Department of Surgery, Tribhuwan University Teaching Hospital, GPO Box No 3578, Maharajgunj, Kathmandu, Nepal e-mail: lakheypj@gmail.com 123 World J Surg (2010) 34:1916–1921 DOI 10.1007/s00268-010-0589-y