Pancreaticoduodenectomy (Whipple's procedure) represents a considerable sur
gical challenge. Postoperative complications are common and typically relat
ed to leakage of pancreatic exocrine secretions following anastomosis failu
re. Pancreatic proteases and lipase leaking from the organ remnant attack t
he surrounding tissue, potentially leading to severe inflammation, tissue n
ecrosis, and fistula formation. In addition, the soft consistency of the no
rmal pancreas can lead to difficulties in manipulating the organ and reduce
the integrity of sutures. Pancreatic fistula is the most serious postopera
tive complication and especially common following resectional surgery for m
alignant disease. Through prophylactic inhibition of digestive secretions,
it should be possible to reduce postoperative morbidity after pancreatic su
rgery. One such inhibitor is somatostatin-14, an endogenous peptide hormone
with pronounced effects on secretion of pancreatic enzymes and hormones, g
astrointestinal secretions, and pancreatic blood flow, all of which may dec
rease the risk of postoperative complications. A limited number of randomis
ed controlled trials have investigated prophylactic administration of somat
ostatin-14 and the synthetic somatostatin analogue octreotide in reducing c
omplications following pancreatic surgery. While the majority of studies wi
th octreotide demonstrated a significant reduction in the overall complicat
ion rate, the benefits appeared less marked in relation to events specifica
lly related to pancreatic secretion. However, preliminary results from a li
mited number of trials with somatostatin-14, administered as a continuous i
ntravenous infusion, suggest that prophylactic pharmacotherapy produces a s
ignificant decrease in fistula formation and secretion related events after
pancreaticoduodenectomy. Due to these promising data, further investigatio
n of the role of somatostatin-14 prophylaxis in pancreatic surgery is warra
nted in large well controlled trials.