EXPERIENCE OF WHIPPLE’S PROCEDURE AT A TERTIARY CARE LEVEL HOSPITAL IN THE DEVELOPING WORLD- A PIMS EXPERIENCE

Abstract

Objective: To assess and evaluate experience of Whipple’s procedure in terms of morbidity and mortality in a tertiary care hospital of a developing country. Materials and Methods: A retrospective study was conducted at General Surgery department in Pakistan Institute of Medical Sciences Islamabad. Data of all adult patients (Age> 12 years) undergoing Whipple’s procedure performed from January 2007 to December 2019 was collected from hospital record. A multivariate performa was used to record personal data of the patients, patient presentation, duration of hospital stay, duration of surgery, histological type, morbidities associated with the procedure and overall mortality. Data was then entered in SPSS version 20 and analyzed using chi square and T test. Results: A total of 227 patients were included in the study with 187 (82.4%) male patients and 40 (17.6%) female patients. Mean age of the participants was 57.3 ± 6.4. There was a mean operating time of 312 ± 34 minutes for Whipple’s procedure. Mean length of hospital stay after surgery was 9.4 ± 3.2 days. A total of 37 cases (16.29%) developed wound infections where as complications like pancreatic fistula (n=5), Biliary fistula (n=1), bleeding (n=2), gangrenous Roux en Y loop (n=1) were less commonly present. Postoperative hematemesis requiring re-exploration was seen in 3 patients (1.3%) whereas 11 patients (4.84%) developed Systemic Inflammatory Response Syndrome (SIRS). There was an overall mortality of 3.96% (n=9). Conclusion: Outcomes of Whipple’s procedure in our institute are comparable with literature from other high volume centers.