Two open whipples a day: Excessive or efficient

Rachel E. Simpson, Mitchell L. Fennerty, Katelyn F. Flick, Cameron L. Colgate, Eugene P. Ceppa, Michael G. House, Nicholas J. Zyromski, Attila Nakeeb, C. Max Schmidt

Research output: Contribution to journalArticle


Background: Demand for pancreatic surgery is rising, occasionally necessitating consecutive PDs to be performed by a single surgeon in the same workday. The safety of this practice is unknown. Methods: Institutional prospective ACS-NSQIP data were reviewed for PDs (2013–2017). Instances where a single surgeon performed two PDs in the same day were a PD pair (PD1, PD2) and compared with univariable analysis. Paired vs. unpaired-PD matched analyses were performed. Results: 661 PDs (25-PD pairs) were performed. PD1 and PD2 revealed similar infectious (12% vs16%), pulmonary (8% vs8%), cardiovascular (12% vs4%), and aggregate (24% vs24%) morbidity (P>0.05). Pancreatic fistula (B + C 0%), delayed gastric emptying (4% vs12%), hospital stay (9.3 vs8.8 days), and 30-day mortality (4% vs4%) were similar (P > 0.05). Matched outcomes were similar except higher cardiovascular morbidity for paired vs. unpaired PD (7% vs0%; P = 0.015). Conclusion: With proper patient selection, and in experienced hands at high-volume centers, two consecutive open PDs may be safely performed.

Original languageEnglish (US)
Pages (from-to)390-393
Number of pages4
JournalAmerican Journal of Surgery
Issue number3
StatePublished - Mar 2020


  • Pancreatoduodenectomy
  • Safety
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery

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