Background: Periampullary adenocarcinomas are a set of neoplasms that arise near the ampullaof vater. Although they are all adenocarcinomas, they arise from the different mucosal tissues of the pancreatic duct, bile duct, ampulla, and duodenum, they are treated with pancreaticoduodenectomy also known as whipples procedure, which is a complex, high risk surgical procedure. Before 1980,pancreaticoduodenectomy has been associated with a high rate of morbidity(40%-60%) and a high mortality rate up to 20%1 . Since that time, the in-hospitalmortality rate has decreased substantially with high-volume tertiary care centers reporting in-hospital mortality rate of 4% or less2,3. Luft et al. 4 provided theempirical relationship between higher surgical volume and lower post-operative mortality