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Am J Surg. 2020 Mar;219(3):390-393. doi: 10.1016/j.amjsurg.2019.10.043. Epub 2019 Nov 12.

Two open whipples a day: Excessive or efficient.

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Indiana University School of Medicine Department of Surgery, Indianapolis, IN, USA.
Center for Outcomes Research in Surgery, Indianapolis, IN, USA.
Indiana University School of Medicine Department of Surgery, Indianapolis, IN, USA; Indiana University School of Medicine Department of Biochemistry/Molecular Biology, Indianapolis, IN, USA. Electronic address:



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.


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.


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).


With proper patient selection, and in experienced hands at high-volume centers, two consecutive open PDs may be safely performed.


Pancreatoduodenectomy; Safety; Surgical outcomes

Conflict of interest statement

Declaration of competing interest None declared.

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