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Pancreatoduodenectomy (Hardcover, 1997 ed.)
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Pancreatoduodenectomy (Hardcover, 1997 ed.)
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Alessandro Condivilla of Bologna first attempted a resection of the
head of the pan creas in 1898, but several decades of further
trial-and-error attempts ensued before the prototype procedure of
pancreatoduodenectomy (PD) was established by Whipple in 1935. In
the half-century following that landmark, refinements of surgical
technique, including pancreatico-and bilio-entero anastomosis as
well as develop ment of new technology to support perioperative
management and patient care have contributed to the decrease in
mortality and morbidity rates for obstructive jaundice and
pancreatic fistula. The improvement in mortality and morbidity
rates associated with PD has led to an increase in the number of
patients undergoing the procedure and in the number of institutions
performing it. Indications for PD have also been expanded. In the
early years after PD was established as a viable procedure,
periampullary carcinoma was the most common indication; now PD is
indicated for a number of benign and malignant diseases. Some
surgeons believe that PD is the procedure of choice for certain
types of chronic pancreatitis, pancreatico-biliary maljunction, and
pancreatic and duodenal trauma. Other surgeons have reported the
necessity of PD for lymph node dissection of gallbladder carcinoma.
Consequently, the basic procedure has been greatly modi fied to
accommodate the specific conditions of each disease. For patients
with malig nancy, extended procedures have been developed to
improve the curative resection rate and ensure complete lymph node
dissection.
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