Juan Sarmiento performs 1000th Whipple procedure

July 2020

Juan Sarmiento

Shortly after joining the Emory Department of Surgery in May 2003, Juan M. Sarmiento, MD, professor of surgery and W. Dean Warren Distinguished Chair of Surgery, performed his first Emory-based Whipple procedure at Emory University Hospital. Fast forward 17 years to July 23, 2020, and he achieved the major milestone of performing his 1000th Whipple at Emory, an amazing accomplishment by any estimation.

"Only a handful of surgeons in the world have done this many Whipple surgeries," says Edward Lin, DO, chief of the Division of General and GI Surgery. "Juan is a master of this complex procedure, and both Emory and his patients have benefited from his expertise."

The procedure bears the name of Allen Whipple, MD, who developed and championed the operation in the 1930s. Over time the Whipple has become generally viewed as the best way to remove pancreatic cancer when found in the head of the pancreas. This aggressive operation — which can take four-to-six hours to perform — removes a third of the pancreas, the first part of the small intestine known as the duodenum, a portion of the bile duct, and the gallbladder.

During Dr. Sarmiento's two years of training as a GI surgical scholar in hepatopancreatobiliary surgery at the Mayo Clinic under the mentorship of David Nagorney, MD, and Michael Farnell, MD, mastering the Whipple was one of his goals. Drs. Nagorney and Farnell were early advocates of the procedure, the validity of which had been questioned periodically throughout the 1980s and early 1990s due to its complexity and then-high rates of morbidity and mortality.

"By the early 2000s, my mentors at Mayo found that improved diagnostic techniques allowed for more appropriate selection of candidates, as well as refinements in surgical methods, anesthesia support, and postoperative care, all of which had made the Whipple a more reliable resection approach for pancreatic tumors and certain benign conditions," says Dr. Sarmiento. "Working with them in the OR and observing their tricks of the trade contributed to my determination to move forward with my own work to refine the Whipple procedure."

At Emory, Dr. Sarmiento has continued to evaluate, test, and modify methods of performing pancreaticoduodenectomy, another name for the Whipple procedure, with special attention given to lessening the physiologic impact of this formidable operation. His specific innovations have included minimizing invasive perioperative monitoring, using smaller incisions, and developing simplified clinical pathways for achieving the necessary resections. These refinements have been shown to reduce postoperative stays, readmissions, and extend survival.

Dr. Sarmiento has also overseen the process of strengthening and streamlining the patient evaluation system for pancreaticoduodenectomy and has spearheaded collaborative protocols with Emory radiology and pathology physicians and staff to determine the best course of treatment for patients.

"Whichever way it is done, I believe that the Whipple procedure generally offers patients with pancreatic and periampullary cancers the best chance for a cure," he says.