Forgotten pioneers of pancreatic surgery - Beyond the favorite few

Who would associate a small-town German physician by the name of Friedrich Wilhelm Wandesleben with the performance of the first reported operation on the human pancreas or the German surgeon Oskar Ehrhardt with the first successful partial pancreatoduodenectomy? Along with other pioneers of pancreatic surgery, they have been essentially forgotten and, to the best of our knowledge, have not been cited or credited by others in modem literature. The intent of this review is to shine light on a piece of lost history in our profession. Creation of operative pancreatic fistulae, as well as more complex partial pancreatic resections, was performed on animals as early as the 1660s.(1,2) Yet the pancreas remained for the longest time a mysterious and misunderstood organ, off limits to therapeutic interventions. Until the 1880s, only pathologists showed any practical interest in pancreatic diseases because of the lack of safe methods of diagnosis and treatment by clinicians.(3) Laboratory tests to diagnose pancreatic dysfunction were not available until introduction of the Cammidge reaction (Cammidge reaction is a somewhat unscientific laboratory test assessing crystal formation in chemically treated urine, most likely assessing glycosuria) from urine in 1900 and the detection of serum amylase activity in 1908.(4,5) The first radiographic visualization of the pancreas (or more precisely of pancreatic calcifications) was not described until 1911.(6) The development of pancreatic surgery eventually paralleled the diagnostic understanding of pancreatic disease and the improvements in intra-abdominal operative techniques and postoperative patient care. Major resections of the pancreas were for the longest time considered futile because of limited techniques of hemostasis, the absence of adequate resuscitation, and the lack of postoperative nutritional support. The use of thermocautery for hemostasis and postoperative resuscitation with saline solutions in pancreatic surgery was first mentioned by Franke(7) in 1900. With the development of blood typing and the introduction of anticoagulants for blood storage, blood transfusion became available in the late 1920s.(8,9) The recognition of the role of vitamin K in 1929 and the ability to give exogenous vitamin K preoperatively added another key piece.(10) The accumulation of those and many other small steps eventually opened the doors to the growth of modem pancreatic surgery.