Surgical treatment of carcinoma of the ampulla of Vater and the extrahepatic bile ducts

THE TECHNIC for partial duodenopancreatectomy described in 1935 by Whipple and his associates1has given impetus and encouragement for the radical treatment of tumors arising in a region previously considered inaccessible. Prior to this time, attempts had been made to resect ampullary tumors by a transduodenal approach; however, the results were by no means satisfactory, and the complications which arose in operating on jaundiced patients usually did not justify the procedures. It is hardly remarkable that before the advent of methods for controlling the tendency toward bleeding in the presence of jaundice palliative operations were usually performed. The use of vitamin K, a better understanding of the function of the liver and better preoperative preparation and postoperative management in conjunction with improved technical procedures have made possible wide excision of carcinoma of this region. During the past eleven years, some modifications of the original two stage operation as performed