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Book Details
Abstract
Editor Jessica Wernberg and authors review the current management and procedures in biliary tract surgery. Articles will cover: anatomy and embryology of the biliary tract, bile duct cysts, symptomatic cholelithiasis and functional disorders of the biliary tract, gallstone pancreatitis, technical aspects of bile duct evaluation and exploration, iatrogenic biliary injuries, proximal biliary malignancy, distal biliary malignancy, gallbladder cancer, bile duct metabolism and lithogenesis, unusual complications of gallstones, endoscopic management of biliary disorders, biliary issues in the bariatric population, technical aspects of cholecystectomy, cholecystitis, and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Biliary Tract Surgery | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Surgical Clinics\rOf North America\r | xii | ||
| Foreword\r | xiii | ||
| Preface\r | xv | ||
| Anatomy and Embryology of the Biliary Tract | 203 | ||
| Key points | 203 | ||
| Introduction | 203 | ||
| Embryology | 204 | ||
| General Biliary Embryology | 204 | ||
| Cell Signaling in Biliary Development | 205 | ||
| Congenital disorders of the biliary tract | 205 | ||
| Biliary Atresia | 205 | ||
| Choledochal Cysts | 205 | ||
| Gallbladder Agenesis | 206 | ||
| Biliary anatomy | 207 | ||
| Classic Extrahepatic Biliary Anatomy | 207 | ||
| Variations in Extrahepatic Biliary Anatomy | 209 | ||
| Variations in Hepatic Artery Anatomy | 210 | ||
| The gallbladder | 211 | ||
| Gallbladder Anatomy | 211 | ||
| Ducts of Luschka | 213 | ||
| Ampullary anatomy and physiology | 214 | ||
| SOD | 215 | ||
| Summary | 216 | ||
| References | 216 | ||
| Biliary Cysts | 219 | ||
| Key points | 219 | ||
| Introduction | 219 | ||
| Classification schemes | 220 | ||
| Cause | 222 | ||
| Risk of malignancy | 225 | ||
| Type I cysts | 226 | ||
| Type II cysts | 227 | ||
| Type III cysts | 228 | ||
| Type IV cysts | 228 | ||
| Type V cysts | 229 | ||
| A simplified approach | 229 | ||
| Summary | 230 | ||
| References | 231 | ||
| Symptomatic Cholelithiasis and Functional Disorders of the Biliary Tract | 233 | ||
| Key points | 233 | ||
| Symptomatic cholelithiasis | 233 | ||
| Epidemiology | 234 | ||
| Pathophysiology | 234 | ||
| Clinical Presentation | 234 | ||
| Diagnostic Procedures | 235 | ||
| Treatment and Outcomes | 236 | ||
| Summary | 236 | ||
| Functional disorders of the biliary tract: biliary dyskinesia and sphincter of Oddi dysfunction | 236 | ||
| FGD | 237 | ||
| Epidemiology | 238 | ||
| Pathophysiology | 238 | ||
| Clinical Presentation | 238 | ||
| Diagnostic Procedures | 238 | ||
| Treatment and Outcomes | 240 | ||
| Summary | 241 | ||
| Functional SOD | 241 | ||
| Epidemiology | 241 | ||
| Pathophysiology | 242 | ||
| Clinical Presentation | 243 | ||
| Diagnostic Procedures | 243 | ||
| Treatment for Biliary SOD | 245 | ||
| Treatment for Pancreatic SOD | 248 | ||
| Summary | 249 | ||
| References | 249 | ||
| Gallstone Pancreatitis:\rA Review | 257 | ||
| Key points | 257 | ||
| Introduction | 257 | ||
| Epidemiology | 258 | ||
| Pathophysiology | 258 | ||
| Diagnosis | 259 | ||
| History and Physical Examination | 259 | ||
| Laboratory Evaluation | 259 | ||
| Imaging | 260 | ||
| Ultrasonography | 260 | ||
| Computed tomography | 261 | ||
| Magnetic resonance imaging | 261 | ||
| Endoscopic ultrasonography | 262 | ||
| Management | 262 | ||
| Indices of Severity | 263 | ||
| Initial Management | 265 | ||
| Nutrition | 265 | ||
| Antibiotics | 265 | ||
| Interventions | 265 | ||
| Cholecystectomy | 266 | ||
| Cholecystostomy | 268 | ||
| Intraoperative cholangiography | 268 | ||
| Laparoscopic exploration of common bile duct | 269 | ||
| Endoscopic retrograde cholangiopancreatography | 270 | ||
| Special patient populations | 271 | ||
| Summary | 272 | ||
| References | 272 | ||
| Technical Aspects of Bile Duct Evaluation and Exploration | 281 | ||
| Key points | 281 | ||
| Introduction | 281 | ||
| Preoperative cholangiography | 282 | ||
| Indications | 282 | ||
| Magnetic Resonance Cholangiopancreatography Versus ERCP | 282 | ||
| Intraoperative cholangiography | 283 | ||
| Ultrasound Cholangiography | 285 | ||
| Ultrasonography technique | 285 | ||
| Fluoroscopic Cholangiography | 285 | ||
| Fluoroscopic technique | 286 | ||
| CBDE | 287 | ||
| Laparoscopic CBDE | 287 | ||
| Transcystic technique | 288 | ||
| Transcholecystic technique | 289 | ||
| Choledochotomy technique | 289 | ||
| Open CBDE | 291 | ||
| Intraoperative ERCP | 292 | ||
| Postoperative ERCP | 292 | ||
| Resident training implications | 293 | ||
| References | 293 | ||
| Iatrogenic Biliary Injuries | 297 | ||
| Key points | 297 | ||
| Introduction | 297 | ||
| Classification | 298 | ||
| Bismuth and Strasberg Classifications | 298 | ||
| Stewart-Way Classification | 298 | ||
| Identification of bile duct injury | 301 | ||
| Intraoperative Bile Duct Injury | 301 | ||
| Postoperative Bile Duct Injury | 303 | ||
| Complete cholangiography | 303 | ||
| Concomitant vascular injury | 303 | ||
| Management | 304 | ||
| Preoperative Evaluation | 304 | ||
| Preoperative Patient Preparation | 304 | ||
| Surgical Management Principles | 304 | ||
| Specific Biliary Injuries | 305 | ||
| Cystic duct leaks | 305 | ||
| Class I injuries | 305 | ||
| Bile duct injuries recognized intraoperatively | 305 | ||
| Class IV injuries | 305 | ||
| Timing of Biliary Reconstruction | 306 | ||
| Summary | 306 | ||
| References | 306 | ||
| Proximal Biliary Tumors | 311 | ||
| Key points | 311 | ||
| Introduction: nature of the problem | 311 | ||
| Intrahepatic cholangiocarcinoma | 313 | ||
| Clinical presentation and workup | 313 | ||
| Imaging | 313 | ||
| Staging | 314 | ||
| Therapeutic options and surgical techniques | 314 | ||
| Clinical outcomes | 315 | ||
| Hilar cholangiocarcinoma | 316 | ||
| Clinical presentation and workup | 316 | ||
| Imaging | 316 | ||
| Tissue Diagnosis | 317 | ||
| Staging | 318 | ||
| Therapeutic options and surgical techniques | 318 | ||
| Surgical Resection | 318 | ||
| Transplantation | 320 | ||
| Adjuvant Therapy | 320 | ||
| Palliative Treatment | 320 | ||
| Clinical outcomes | 320 | ||
| Summary | 321 | ||
| References | 321 | ||
| Distal Cholangiocarcinoma | 325 | ||
| Key points | 325 | ||
| Epidemiology | 326 | ||
| Risk factors for DCC | 326 | ||
| Clinical: Social | 326 | ||
| Clinical: Disease Specific | 326 | ||
| Primary sclerosing cholangitis | 326 | ||
| Choledochal cyst | 327 | ||
| Parasitic Infections | 327 | ||
| Biologic basis of cholangiocarcinogenesis | 327 | ||
| Inflammatory Mediators | 327 | ||
| Growth Factors | 328 | ||
| Stromal Alterations | 328 | ||
| Genetic Aberrations | 328 | ||
| Clinical presentation and evaluation | 328 | ||
| Principles of surgical technique | 329 | ||
| Pathologic analysis | 330 | ||
| Specimen Orientation and Margin Assessment | 330 | ||
| SMA (Retroperitoneal/Uncinate) Margin | 331 | ||
| Posterior (Retroperitoneal) Margin | 331 | ||
| Portal Vein Groove Margin | 332 | ||
| Pancreatic Neck (Transection) Margin | 332 | ||
| Bile Duct Margin | 332 | ||
| Specimen Grossing Technique and Extent of Tissue Sampling | 332 | ||
| Staging and prognosis | 335 | ||
| Postoperative therapy for locoregional disease | 336 | ||
| Palliation for patients with unresectable disease and/or distant metastases | 337 | ||
| Summary | 337 | ||
| References | 338 | ||
| Gallbladder Cancer | 343 | ||
| Key points | 343 | ||
| Introduction | 343 | ||
| Incidence and epidemiology | 343 | ||
| Risk factors | 344 | ||
| Gallstones | 344 | ||
| Gallbladder Polyps | 344 | ||
| Infection | 345 | ||
| Anomalous Junction | 345 | ||
| Porcelain Gallbladder | 345 | ||
| Genetics | 346 | ||
| Sex | 346 | ||
| Others | 346 | ||
| Anatomy | 347 | ||
| Pathology | 347 | ||
| Staging/Prognosis | 348 | ||
| Preoperative imaging | 348 | ||
| Incidentally identified gallbladder cancer | 350 | ||
| Operative management | 351 | ||
| Primary Operation (Known or Suspected Malignancy) | 351 | ||
| Secondary Operation (After Incidental Discovery of Malignancy) | 352 | ||
| Residual Disease | 352 | ||
| Management of the Liver Bed | 353 | ||
| Management of the Cystic Duct Stump and Extrahepatic Bile Ducts | 353 | ||
| Role of Lymphadenectomy | 354 | ||
| Diagnostic Laparoscopy | 354 | ||
| Port Site Management | 355 | ||
| Adjuvant therapy/palliative therapy | 355 | ||
| Summary | 356 | ||
| References | 356 | ||
| Bile Metabolism and Lithogenesis | 361 | ||
| Key points | 361 | ||
| Introduction | 361 | ||
| Bile metabolism | 361 | ||
| Function of Bile Acids | 362 | ||
| Bile Composition | 362 | ||
| Bile Acid Synthesis | 362 | ||
| Enterohepatic circulation | 363 | ||
| Interorgan Transport | 363 | ||
| Intracellular Transport | 363 | ||
| Modifications by Gut Bacteria | 364 | ||
| FXR | 364 | ||
| Gallbladder disease | 365 | ||
| Lithogenesis | 365 | ||
| Cholesterol stones | 366 | ||
| Risk factors | 366 | ||
| Ethnicity/geography | 367 | ||
| Genetics | 367 | ||
| Sex | 367 | ||
| Age | 368 | ||
| Dietary factors | 368 | ||
| Obesity | 368 | ||
| Rapid weight loss | 368 | ||
| Dyslipidemia | 369 | ||
| Drugs | 369 | ||
| Diabetes mellitus | 369 | ||
| Pigment stones | 369 | ||
| Brown stones | 369 | ||
| Black stones | 370 | ||
| Complications of Cholelithiasis | 370 | ||
| Disease States Causing Altered Bile Acid Metabolism | 370 | ||
| Summary | 371 | ||
| References | 371 | ||
| Unusual Complications of Gallstones | 377 | ||
| Key points | 377 | ||
| Introduction | 377 | ||
| Biliary fistula | 378 | ||
| Internal Fistula | 378 | ||
| Bilio-biliary fistula | 378 | ||
| Mirizzi syndrome | 378 | ||
| Background | 378 | ||
| Pathophysiology | 378 | ||
| Classification | 378 | ||
| Clinical presentation | 379 | ||
| Diagnosis | 379 | ||
| Treatment | 379 | ||
| Biliary-enteric fistula | 380 | ||
| Gallstone ileus | 381 | ||
| Background | 381 | ||
| Clinical presentation | 381 | ||
| Treatment | 383 | ||
| Bouveret syndrome | 384 | ||
| Biliary-vascular fistula | 385 | ||
| Hemobilia | 385 | ||
| Bilhemia | 386 | ||
| Biliary-thoracic fistula | 387 | ||
| Biliary-genitourinary fistula | 387 | ||
| External | 388 | ||
| Lost gallstones | 388 | ||
| Summary | 390 | ||
| References | 390 | ||
| Endoscopic Management of Biliary Disorders | 395 | ||
| Key points | 395 | ||
| Introduction | 395 | ||
| Diagnostic ERCP | 396 | ||
| Primary Sclerosing Cholangitis | 397 | ||
| Indeterminate Biliary Strictures | 397 | ||
| Sphincter of Oddi Manometry | 398 | ||
| Therapeutic ERCP | 398 | ||
| CBD Stones | 399 | ||
| Benign Biliary Strictures | 399 | ||
| Bile Duct Leaks | 401 | ||
| Transpapillary Gallbladder Drainage | 401 | ||
| Ampullary Adenoma | 401 | ||
| Malignant Biliary Obstruction | 403 | ||
| Distal (nonhilar) malignant obstruction | 403 | ||
| Hilar malignant obstruction | 403 | ||
| Therapeutic ERCP in Patients with Surgically Altered Anatomy | 404 | ||
| Novel Percutaneous-Endoscopic Access Approaches | 405 | ||
| Endoscopic ultrasound | 405 | ||
| Diagnostic EUS | 405 | ||
| Therapeutic EUS | 406 | ||
| Biliary drainage | 406 | ||
| Gallbladder drainage | 407 | ||
| Drainage of liver abscesses | 407 | ||
| Drainage of bilomas | 407 | ||
| Adverse events | 407 | ||
| Summary | 407 | ||
| References | 408 | ||
| Biliary Issues in the Bariatric Population | 413 | ||
| Key points | 413 | ||
| Introduction | 413 | ||
| Cholelithiasis | 414 | ||
| Biliary imaging in the bariatric population | 415 | ||
| Prevention of cholelithiasis | 415 | ||
| Post–gastric bypass management of gallstone disease | 416 | ||
| Cholelithiasis | 416 | ||
| Choledocholithiasis | 417 | ||
| Biliary tract access after RYGBP | 418 | ||
| Percutaneous Transhepatic Cholangiography | 418 | ||
| Balloon-assisted Endoscopy | 418 | ||
| Percutaneous Transgastric ERCP | 419 | ||
| Summary | 421 | ||
| References | 422 | ||
| Technical Aspects of Cholecystectomy | 427 | ||
| Key points | 427 | ||
| Introduction | 428 | ||
| Preoperative planning | 430 | ||
| Surgical techniques | 430 | ||
| Laparoscopic cholecystectomy | 431 | ||
| Creation of Pneumoperitoneum | 432 | ||
| Insertion of Trocars | 432 | ||
| Dissection of Adhesions | 433 | ||
| Retraction and Exposure of Gallbladder | 433 | ||
| Opening of the Serosal Layer that Surrounds the Cystic Duct and Artery | 434 | ||
| Dissection of Both Structures and Achievement of the Critical View of Safety | 435 | ||
| Intraoperative Cholangiogram | 435 | ||
| Clipping and Section of Cystic Duct and Artery | 436 | ||
| Dissection of the Gallbladder from the Liver Bed | 436 | ||
| Irrigation and Control of Hemostasis | 437 | ||
| Extraction of the Gallbladder | 437 | ||
| Trocar Retrieval and Closure of Incisions | 437 | ||
| Tips and Tricks for Avoiding Complications | 437 | ||
| Important Steps in Avoiding Bile Duct Injury | 438 | ||
| Postoperative Management | 438 | ||
| Complications | 438 | ||
| Open cholecystectomy | 439 | ||
| Natural orifice transluminal endoscopic surgery transvaginal cholecystectomy | 440 | ||
| Patient Selection | 441 | ||
| Surgical Technique | 441 | ||
| Umbilical laparoscopic access | 442 | ||
| Transvaginal access | 442 | ||
| Gallbladder retraction | 442 | ||
| Dissection of the hepatic hilum and triangle of Calot | 444 | ||
| Dissection of gallbladder from the liver bed | 446 | ||
| Extraction of the gallbladder | 447 | ||
| Vaginal closure | 449 | ||
| Results | 449 | ||
| Complications | 449 | ||
| Single-incision laparoscopic cholecystectomy | 450 | ||
| Incision and Trocar Placement | 450 | ||
| Gallbladder Retraction and Exposure | 451 | ||
| Dissection of the Hepatic Hilum and Triangle of Calot | 451 | ||
| Dissection of the Gallbladder from the Liver Bed and Control of Hemostasis | 451 | ||
| Extraction of the Gallbladder | 451 | ||
| Wound Closure | 451 | ||
| Summary | 453 | ||
| Acknowledgments | 453 | ||
| Supplementary data | 453 | ||
| References | 453 | ||
| Cholecystitis | 455 | ||
| Key points | 455 | ||
| Overview | 455 | ||
| Epidemiology | 455 | ||
| Risk factors | 456 | ||
| Gallstone formation | 456 | ||
| Acute cholecystitis | 456 | ||
| Pathophysiology | 456 | ||
| Clinical Presentation | 457 | ||
| Imaging | 458 | ||
| Management of Acute Cholecystitis | 460 | ||
| Timing of Operation | 460 | ||
| Type of operation | 462 | ||
| Laparoscopic Cholecystectomy | 462 | ||
| Open Cholecystectomy | 463 | ||
| Intraoperative Imaging of the Common Bile Duct | 464 | ||
| Acalculous cholecystitis | 464 | ||
| Pathophysiology | 464 | ||
| Clinical Presentation | 465 | ||
| Imaging | 465 | ||
| Treatment | 465 | ||
| Chronic cholecystitis | 466 | ||
| Pathophysiology | 466 | ||
| Clinical Presentation | 466 | ||
| Imaging | 466 | ||
| Management | 466 | ||
| Special considerations: acute cholecystitis in pregnancy | 466 | ||
| Summary | 467 | ||
| References | 467 | ||
| Postscript | A1 | ||
| Small Bowel and Colon Perforation | 471 | ||
| Key points | 471 | ||
| Introduction | 471 | ||
| Clinical presentation/examination | 471 | ||
| Diagnostic procedures | 472 | ||
| Causes and treatment | 472 | ||
| Mechanical Obstruction | 472 | ||
| Inflammatory Bowel Disease | 472 | ||
| Diverticular Disease | 473 | ||
| Ischemia | 473 | ||
| Radiation Enteritis | 473 | ||
| Foreign Body | 474 | ||
| Infectious | 474 | ||
| Summary | 474 | ||
| References | 475 | ||
| Index | 477 |