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Book Details
Abstract
Hepatobiliary & Pancreatic Surgery meets the needs of surgeons in higher training and practising consultants for a contemporary and evidence-based account of this sub-specialty that is relevant to their general surgical practice. It is a practical reference source incorporating the most current information on recent developments, management issues and operative procedures. The text is thoroughly referenced and supported by evidence-based recommendations wherever possible, distinguishing between strong evidence to support a conclusion, and evidence suggesting that a recommendation can be reached on the balance of probabilities.
This is a title in the Companion to Specialist Surgical Practice series whose eight volumes are an established and highly regarded source of information for the specialist general surgeon.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within each major surgical sub-specialty.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
- An expanded authorship team across the series includes additional European and World experts with an increased emphasis on global practice.
- The contents of the series have been extensively revised in line with recently published evidence.
- The contents highlight the increasing use of laparoscopic surgical technique in the management of HPB disease.
- The contributions incorporate the latest oncological approaches to the management of HPB malignancy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Hepatobiliary and Pancreatic Surgery: A COMPANION TO SPECIALIST SURGICAL PRACTICE | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Contributors | vii | ||
| Series Editors' preface | ix | ||
| Editors' preface | xi | ||
| Acknowledgements | xi | ||
| Evidence-based practice in surgery | xiii | ||
| Chapter 1: Liver function and failure | 1 | ||
| Overview of liver functions and evolution | 1 | ||
| Symptoms of liver failure: acute and chronic | 1 | ||
| Common causes of acute liver failure: hepatic insufficiency following liver resections | 2 | ||
| Chronic liver failure | 3 | ||
| Metabolic liver function | 3 | ||
| Measuring liver volume | 4 | ||
| Blood tests of liver function | 5 | ||
| Tests of liver function measuring substance clearance | 5 | ||
| Indocyanine green (ICG) | 6 | ||
| Hepatobiliary scintigraphy | 6 | ||
| Lidocaine (MEG-X) | 6 | ||
| Aminopyrine breath test | 6 | ||
| Urea synthesis | 6 | ||
| Glutathione synthesis | 7 | ||
| Measuring liver blood flow | 7 | ||
| Effect of major liver resection on hepatic blood flow | 8 | ||
| Effect of major liver resection on innate immunity | 8 | ||
| Liver regeneration | 9 | ||
| Molecular signals for hepatic regeneration | 9 | ||
| Cell populations involved in liver regeneration | 9 | ||
| Consequences of surgery | 10 | ||
| Small-for-size syndrome | 10 | ||
| Hepatic steatosis | 11 | ||
| Assessment of steatosis | 11 | ||
| Chemotherapy-induced liver changes | 11 | ||
| Portal vein embolisation | 11 | ||
| Technique | 12 | ||
| Therapy for liver failure | 13 | ||
| N -Acetyl cysteine | 13 | ||
| Nutritional support in liver failure | 13 | ||
| Artificial extracorporeal liver support | 13 | ||
| Artificial liver support | 13 | ||
| Bioartificial liver systems | 13 | ||
| Liver transplantation | 14 | ||
| Cell therapy for liver failure: general principles | 14 | ||
| Haemopoetic stem cell therapy for liver disease in humans | 14 | ||
| Future developments | 15 | ||
| References | 15 | ||
| Chapter 2: Hepatic, biliary and pancreatic anatomy | 17 | ||
| Liver | 17 | ||
| Overview of hepatic anatomy and terminology | 17 | ||
| Divisions of the liver based on the hepatic artery | 17 | ||
| Resectional terminology | 20 | ||
| Surgical anatomy for liver resections | 21 | ||
| Hepatic arteries and liver resections | 21 | ||
| Bile ducts and liver resections | 22 | ||
| Prevailing pattern and important variations of bile ducts draining the right hemiliver | 22 | ||
| Prevailing pattern and important variations of bile ducts draining the left hemiliver | 23 | ||
| Prevailing pattern of bile ducts draining the caudate lobe (Sg1) | 24 | ||
| Portal veins and liver resections | 24 | ||
| Ramification of the left portal vein (Figs 2.10 and 2.11) | 24 | ||
| Hepatic veins and liver resection (Fig. 2.13) | 26 | ||
| The plate/sheath system of the liver | 28 | ||
| Liver capsule and attachments | 29 | ||
| Surface anatomy | 30 | ||
| Gallbladder and extrahepatic bile ducts | 30 | ||
| Gallbladder | 30 | ||
| Agenesis of the gallbladder | 30 | ||
| Double gallbladder | 30 | ||
| Cystic duct | 30 | ||
| Cystic artery | 31 | ||
| Extrahepatic bile ducts | 31 | ||
| Anomalies of extrahepatic bile ducts | 32 | ||
| Extrahepatic arteries | 32 | ||
| Blood supply of bile ducts | 32 | ||
| Pancreas | 34 | ||
| Pancreatic ducts | 34 | ||
| Blood supply of the pancreas | 34 | ||
| Lymphatics of the pancreas | 35 | ||
| Anatomical relations and ligaments of the pancreas | 36 | ||
| References | 37 | ||
| Chapter 3: Staging and assessment of hepatobiliary malignancies | 39 | ||
| Introduction | 39 | ||
| Colorectal liver metastases | 39 | ||
| Transabdominal ultrasound | 39 | ||
| Computed tomography and magnetic resonance imaging | 40 | ||
| Positron emission tomography | 40 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 41 | ||
| Staging and assesment of resectability | 41 | ||
| Hepatocellular carcinoma | 42 | ||
| Transabdominal ultrasound | 42 | ||
| Computed tomography and magnetic resonance imaging | 42 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 43 | ||
| Staging and assesment of resectability | 43 | ||
| Pancreatic and periampullary carcinoma | 44 | ||
| Transabdominal ultrasound | 44 | ||
| Computed tomography and magnetic resonance imaging | 45 | ||
| Endoscopic retrograde cholangiopancreatography (ERCP) | 45 | ||
| Endoscopic ultrasound | 46 | ||
| Positron emission tomography | 46 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 46 | ||
| Staging and assesment of resectability | 47 | ||
| Proximal bile duct tumours | 50 | ||
| Transabdominal ultrasound | 50 | ||
| Computed tomography and magnetic resonance imaging | 50 | ||
| Endoscopic retrograde cholangiopancreatography | 51 | ||
| Positron emission tomography | 51 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 51 | ||
| Staging and assesment of resectability | 52 | ||
| References | 55 | ||
| Chapter 4: Benign liver lesions | 59 | ||
| Introduction | 59 | ||
| Classification | 60 | ||
| Haemangiomas | 60 | ||
| Pathology | 60 | ||
| Clinical presentation | 61 | ||
| Management | 63 | ||
| Liver cell adenoma | 64 | ||
| Pathology | 64 | ||
| Clinical presentation | 65 | ||
| Management | 65 | ||
| Focal nodular hyperplasia | 65 | ||
| Pathology | 65 | ||
| Clinical features | 67 | ||
| Management | 67 | ||
| Nodular regenerative hyperplasia (macroregenerative nodules) | 68 | ||
| Bile duct adenoma (bile duct hamartoma) | 68 | ||
| Hepatic pseudotumours | 68 | ||
| Miscellaneous benign tumours | 68 | ||
| Liver abscess | 69 | ||
| Clinical presentation | 69 | ||
| Management | 69 | ||
| Amoebic abscess | 70 | ||
| Hydatid cyst | 71 | ||
| Clinical presentation | 71 | ||
| Management | 72 | ||
| Simple cysts of the liver | 73 | ||
| Clinical presentation | 73 | ||
| Chapter 5: Primary malignant tumours of the liver | 80 | ||
| Introduction | 80 | ||
| Hepatocellular carcinoma | 80 | ||
| Incidence of HCC | 80 | ||
| Risk factors for HCC | 81 | ||
| Cirrhosis | 81 | ||
| HBV infection | 81 | ||
| HCV infection | 82 | ||
| Human immunodeficiency virus (HIV) infection | 82 | ||
| Other viral infections | 82 | ||
| Alcohol | 82 | ||
| Non-alcoholic fatty liver disease (NAFLD) | 82 | ||
| Hereditary haemochromatosis | 83 | ||
| Cirrhosis of other aetiologies | 83 | ||
| Aflatoxin | 83 | ||
| Metabolic liver diseases | 83 | ||
| Adenoma, contraceptives and androgens | 84 | ||
| Pathology of HCC and nodular lesions in chronic liver disease | 84 | ||
| Clinical presentation | 85 | ||
| Liver function tests and tumour markers | 86 | ||
| Liver function tests | 86 | ||
| Serum tumour markers | 86 | ||
| α-Fetoprotein | 86 | ||
| Others serum tumour markers | 86 | ||
| Radiological studies | 86 | ||
| Ultrasound | 87 | ||
| Computed tomography | 87 | ||
| Magnetic resonance imaging | 87 | ||
| Contrast-enhanced ultrasound | 88 | ||
| Other imaging | 89 | ||
| Angiography | 89 | ||
| Positron emission tomography | 89 | ||
| Accuracy of imaging techniques | 89 | ||
| Requirement for and reliability of histological assessment | 89 | ||
| Diagnosis of HCC | 89 | ||
| Natural history of HCC and staging systems | 90 | ||
| Screening for HCC | 91 | ||
| Treatment options | 92 | ||
| HCC in normal livers | 92 | ||
| Liver resection of HCC in cirrhotic patients | 93 | ||
| Liver resection | 93 | ||
| Main limitations | 93 | ||
| Risk of surgery and patient selection | 93 | ||
| Technique | 94 | ||
| Outcome after resection | 94 | ||
| Treatment of recurrence | 94 | ||
| Liver transplantation (LT) | 95 | ||
| Rationale | 95 | ||
| Patient selection | 95 | ||
| Treatment on the waiting list | 95 | ||
| Transarterial chemoembolisation (TACE) | 96 | ||
| Technique | 96 | ||
| Contraindications | 96 | ||
| Morbidity and mortality | 96 | ||
| Monitoring | 96 | ||
| Efficacy | 96 | ||
| Percutaneous local ablative therapy | 97 | ||
| Technique | 97 | ||
| Advantages and drawbacks | 97 | ||
| Contraindications and limitations | 98 | ||
| Methods and margins | 98 | ||
| Indication | 98 | ||
| Other palliative treatments | 98 | ||
| Conventional systemic chemotherapy | 98 | ||
| Anti-angiogenic targeted therapies | 99 | ||
| Radioembolisation | 99 | ||
| Other treatments | 99 | ||
| Defining a treatment strategy | 99 | ||
| Uncomplicated HCC associated with chronic liver disease | 99 | ||
| Treatment of complicated HCC | 100 | ||
| HCC with macroscopic portal vein invasion | 100 | ||
| HCC with macroscopic invasion of hepatic veins | 100 | ||
| Ruptured HCC | 100 | ||
| Fibrolamellar carcinoma (FLC) | 100 | ||
| Intrahepatic cholangiocarcinoma (ICCA) | 100 | ||
| Incidence | 101 | ||
| Risk factors | 101 | ||
| Classification and staging | 101 | ||
| Pathology and progression analysis | 101 | ||
| Clinical presentation and laboratory tests | 102 | ||
| Imaging studies | 102 | ||
| Diagnosis | 102 | ||
| Treatment | 102 | ||
| Epithelioid haemangio-endothelioma (EHE) | 103 | ||
| Angiosarcoma | 104 | ||
| Primary hepatic lymphoma | 105 | ||
| References | 106 | ||
| Chapter 6: Colorectal liver metastases | 109 | ||
| Introduction | 109 | ||
| Preoperative staging: the key to selection of candidates for curative treatment | 109 | ||
| Computed tomography (CT) | 109 | ||
| Magnetic resonance imaging (MRI) | 110 | ||
| Positron emission tomography (PET) | 112 | ||
| Staging laparoscopy | 112 | ||
| Cardiopulmonary exercise testing | 113 | ||
| Surgery: the old and the new standards for resection | 114 | ||
| Criteria for resection | 114 | ||
| Surgical strategies to improve resectability | 116 | ||
| Portal vein embolisation | 116 | ||
| Two-stage hepatectomy | 116 | ||
| Repeat hepatectomy | 116 | ||
| Extreme liver surgery | 116 | ||
| Extrahepatic colorectal disease | 116 | ||
| Techniques of surgical resection | 117 | ||
| Transection techniques | 117 | ||
| Fibrin sealants | 117 | ||
| Laparoscopic liver surgery: less is more? | 117 | ||
| Morbidity, mortality and survival after liver resection for CRLMs | 118 | ||
| Classification of CRLMs | 118 | ||
| Staging systems and terminology | 118 | ||
| Chemotherapy for CRLMs | 120 | ||
| Agents | 120 | ||
| Clarifying the intent of chemotherapy in CRLMs | 120 | ||
| Conversion/induction chemotherapy | 120 | ||
| Perioperative chemotherapy | 122 | ||
| Pathological response to chemotherapy as a predictor of long-term outcome | 123 | ||
| Chemotherapy-associated hepatotoxicity | 123 | ||
| Liver-targeted therapies | 124 | ||
| Hepatic arterial infusion | 124 | ||
| Drug-eluting beads for TACE (DEB-TACE) | 124 | ||
| Selective internal radiation treatment (SIRT) | 125 | ||
| Ablative therapies for CRLMs | 125 | ||
| Radiofrequency ablation | 125 | ||
| Microwave ablation | 125 | ||
| Multidisciplinary team approach | 125 | ||
| Conclusions | 126 | ||
| References | 127 | ||
| Chapter 7: Non-colorectal hepatic metastases | 132 | ||
| Introduction | 132 | ||
| Pathophysiology and molecular basis of liver metastases | 133 | ||
| Clinical approach to non-colorectal liver metastases | 134 | ||
| Treatment strategies | 134 | ||
| Neuroendocrine tumours | 134 | ||
| Gastrointestinal stromal tumours | 136 | ||
| Breast cancer | 137 | ||
| Ovarian cancer | 137 | ||
| Renal cell carcinoma | 138 | ||
| Melanoma | 139 | ||
| Non-colorectal gastrointestinal adenocarcinoma | 139 | ||
| Testicular cancer | 140 | ||
| Urothelial cancer | 141 | ||
| Lung cancer | 141 | ||
| Adrenocortical tumours | 141 | ||
| Endometrial cancer | 141 | ||
| Conclusion | 141 | ||
| References | 142 | ||
| Chapter 8: Portal hypertension | 146 | ||
| Introduction | 146 | ||
| Aetiology and pathophysiology of portal hypertension | 146 | ||
| The natural history of portal hypertension | 147 | ||
| Presentation | 148 | ||
| Imaging | 148 | ||
| Management of varices | 148 | ||
| Therapeutic aims for pharmacological therapy in portal hypertension | 149 | ||
| Oesophageal varices | 149 | ||
| Primary prophylaxis for the prevention of variceal haemorrhage | 149 | ||
| Prevention of re-bleeding from oesophageal varices (secondary prophylaxis) | 150 | ||
| Treatment for bleeding oesophageal varices | 152 | ||
| Gastric varices | 152 | ||
| Portal hypertensive gastropathy | 154 | ||
| Second-line therapies | 154 | ||
| TIPS (transjugular intrahepatic portosystemic shunt) | 154 | ||
| TIPS for variceal bleeding | 155 | ||
| Surgical options | 155 | ||
| Portal systemic shunts | 155 | ||
| Liver transplantation | 157 | ||
| Selection of second-line therapy | 157 | ||
| Non-cirrhotic | 157 | ||
| Cirrhotic | 157 | ||
| Management of ascites | 157 | ||
| Budd–Chiari syndrome | 158 | ||
| Acute Budd–Chiari syndrome | 158 | ||
| Chronic Budd–Chiari syndrome | 159 | ||
| Non-cirrhotic portal hypertension | 159 | ||
| Portal vein thrombosis | 159 | ||
| Segmental portal hypertension | 159 | ||
| TIPS and portal vein thrombosis | 159 | ||
| References | 160 | ||
| Chapter 9: The spleen | 164 | ||
| Introduction | 164 | ||
| Postsplenectomy sepsis | 164 | ||
| Trauma | 165 | ||
| Elective indications for splenectomy | 166 | ||
| Immune thrombocytopenic purpura | 166 | ||
| Evans syndrome | 167 | ||
| Hereditary spherocytosis | 167 | ||
| Elliptocytosis | 167 | ||
| Thallassaemias | 167 | ||
| Sickle cell anaemia | 167 | ||
| Autoimmune haemolytic anaemia | 167 | ||
| Lymphoma | 167 | ||
| Myeloid disease | 168 | ||
| Volvulus | 168 | ||
| Haemangiomas | 168 | ||
| Cysts | 168 | ||
| Portal hypertension | 168 | ||
| Preparation for splenectomy | 168 | ||
| Technique | 168 | ||
| Open splenectomy | 168 | ||
| Laparoscopic splenectomy | 169 | ||
| Postoperative management and complications | 171 | ||
| Summary | 171 | ||
| References | 171 | ||
| Chapter 10: Gallstones | 174 | ||
| Introduction | 174 | ||
| Composition, formation and risk factors | 174 | ||
| Presentation | 175 | ||
| Cholecystolithiasis | 175 | ||
| Pathophysiology | 175 | ||
| Chapter 11: Benign biliary tract diseases | 196 | ||
| Introduction | 196 | ||
| Congenital anomalies | 196 | ||
| Biliary atresia | 196 | ||
| Choledochal cysts | 196 | ||
| Classification | 197 | ||
| Risk of malignancy | 197 | ||
| Management | 197 | ||
| Special operative techniques | 198 | ||
| Iatrogenic biliary injury | 199 | ||
| Aetiology | 199 | ||
| Techniques to avoid injury | 199 | ||
| Classification | 201 | ||
| Presentation | 201 | ||
| Management | 203 | ||
| Intraoperative recognition | 203 | ||
| Postoperative recognition: biliary fistula | 203 | ||
| Postoperative recognition: biliary obstruction | 204 | ||
| The timing of repair | 205 | ||
| Early repair | 205 | ||
| Delayed repair | 205 | ||
| Associated vascular injury | 206 | ||
| Further imaging | 206 | ||
| Operative techniques | 207 | ||
| Management of complications related to repair | 208 | ||
| Revisional surgery | 208 | ||
| Liver resection and transplantation | 208 | ||
| Prognosis | 209 | ||
| Success of repair | 209 | ||
| Survival | 209 | ||
| Quality of life | 209 | ||
| Associated malignancy | 209 | ||
| Benign biliary strictures | 209 | ||
| Mirizzi's syndrome | 209 | ||
| Presentation | 210 | ||
| Management | 210 | ||
| Hepatolithiasis | 211 | ||
| Management | 211 | ||
| Parasitic infestation causing jaundice | 211 | ||
| Liver flukes (trematodes) | 211 | ||
| Echinococcus | 212 | ||
| Treatment | 212 | ||
| Ascaris lumbricoides | 212 | ||
| Primary sclerosing cholangitis | 212 | ||
| Aetiology | 212 | ||
| Presentation | 212 | ||
| Investigation | 212 | ||
| Management | 213 | ||
| Exclusion of associated malignant stricture | 213 | ||
| Biliary strictures imitating malignancy | 213 | ||
| Lymphoplasmacytic sclerosing pancreatitis | 213 | ||
| Functional biliary disorders | 214 | ||
| References | 214 | ||
| Chapter 12: Malignant lesions of the biliary tract | 218 | ||
| Introduction | 218 | ||
| Cholangiocarcinoma | 218 | ||
| General considerations | 218 | ||
| Epidemiology | 218 | ||
| Natural history | 218 | ||
| Aetiology | 219 | ||
| Histopathology | 219 | ||
| Cholangiocarcinoma involving the proximal bile ducts (hilar cholangiocarcinoma) | 221 | ||
| Clinical presentation and diagnosis | 221 | ||
| Radiological investigation | 222 | ||
| Direct cholangiography | 222 | ||
| Computed tomography | 222 | ||
| Duplex ultrasonography | 222 | ||
| Magnetic resonance cholangiopancreatography (MRCP) | 223 | ||
| Preoperative evaluation and assessment of resectability | 223 | ||
| Treatment options | 225 | ||
| Resection | 225 | ||
| Results of resection | 226 | ||
| Adjuvant therapy | 227 | ||
| Palliation | 227 | ||
| Percutaneous biliary drainage | 228 | ||
| Intrahepatic biliary-enteric bypass | 228 | ||
| Radiation therapy | 228 | ||
| Photodynamic therapy | 228 | ||
| Chemotherapy | 229 | ||
| Cholangiocarcinoma involving the distal bile duct | 229 | ||
| Clinical presentation and diagnosis | 229 | ||
| Staging and assessment of resectability | 230 | ||
| Treatment options | 230 | ||
| Cholangiocarcinoma involving the intrahepatic bile ducts | 230 | ||
| Clinical presentation | 230 | ||
| Diagnosis | 230 | ||
| Radiological investigations | 231 | ||
| Staging and assessment of resectability | 231 | ||
| Treatment options | 231 | ||
| Gallbladder cancer | 232 | ||
| Epidemiology/aetiology | 232 | ||
| Clinical presentation and diagnosis | 233 | ||
| Histopathology and staging | 234 | ||
| Evidence for an aggressive surgical approach | 235 | ||
| Surgical therapy | 235 | ||
| T1 tumours | 236 | ||
| T2 tumours | 236 | ||
| T3 tumours | 236 | ||
| T4 tumours | 236 | ||
| Preoperative suspicion of malignancy | 236 | ||
| Unsuspected malignancy at exploration | 236 | ||
| Malignancy diagnosed post-cholecystectomy | 237 | ||
| Adjuvant therapy | 237 | ||
| Palliation | 237 | ||
| References | 238 | ||
| Chapter 13: Acute pancreatitis | 244 | ||
| General description | 244 | ||
| Pathophysiology | 244 | ||
| Natural history | 244 | ||
| Diagnosis | 245 | ||
| Aetiology | 246 | ||
| Obstructive factors | 246 | ||
| Biliary disease | 246 | ||
| Benign pancreatic duct stricture | 246 | ||
| Tumours of the ampulla or pancreas | 246 | ||
| Toxic factors | 246 | ||
| Metabolic factors | 246 | ||
| Genetic defects | 246 | ||
| Trauma | 246 | ||
| Iatrogenic causes | 246 | ||
| Inflammatory | 247 | ||
| Physiological | 247 | ||
| Sphincter manometric abnormalities | 247 | ||
| Assessment of severity | 247 | ||
| Single biochemical measures | 247 | ||
| C-reactive protein (CRP) | 247 | ||
| Other single predictive markers | 247 | ||
| Intra-abdominal hypertension (IAH) | 247 | ||
| Repeated clinical assessment | 248 | ||
| Imaging | 248 | ||
| Role of ultrasound (US) | 248 | ||
| Role of CT | 248 | ||
| Role of magnetic resonance (MR)/magnetic resonance cholangiopancreatography (MRCP) | 248 | ||
| Endoscopic ultrasound (EUS) | 249 | ||
| Management | 249 | ||
| Initial management | 249 | ||
| Supportive management | 249 | ||
| Specific medical management | 250 | ||
| Prevention of infection | 250 | ||
| Nutritional support | 250 | ||
| Nutritional delivery in the patient with acute pancreatitis | 250 | ||
| Disease modulation through content or mode of delivery | 250 | ||
| Other medical therapies | 251 | ||
| Inhibition of pancreatic secretion | 251 | ||
| Inhibition of pancreatic enzymes | 251 | ||
| Inhibition of the inflammatory response | 251 | ||
| Role of ERCP | 251 | ||
| Definitive management issues | 251 | ||
| Prevention of recurrent acute pancreatitis | 251 | ||
| Management of gallstones | 251 | ||
| Investigation of non-gallstone-associated pancreatitis | 251 | ||
| Peripancreatic fluid collections | 252 | ||
| Management of an early fluid collection | 252 | ||
| Management of a pseudocyst | 252 | ||
| Percutaneous drainage | 252 | ||
| Endoscopic drainage | 252 | ||
| Surgical drainage of an acute post-inflammatory collection | 252 | ||
| Management of a pancreatic duct fistula | 253 | ||
| Management of necrosis | 253 | ||
| Management of sterile necrosis | 253 | ||
| Management of infected necrosis (early phase, 2–6 weeks) | 254 | ||
| Methods of necrosectomy | 254 | ||
| Open laparotomy/debridement | 254 | ||
| Minimally invasive approaches to infected necrosis | 255 | ||
| Management of pancreatic abscess | 256 | ||
| Specific late complications | 256 | ||
| Haemorrhage | 256 | ||
| Segmental portal hypertension and gastrointestinal haemorrhage | 256 | ||
| Pancreatic duct stricture | 257 | ||
| Gastric outlet obstruction | 257 | ||
| References | 257 | ||
| Chapter 14: Chronic pancreatitis | 260 | ||
| Summary | 260 | ||
| Definition | 260 | ||
| Incidence | 261 | ||
| Aetiology | 261 | ||
| Clinical course | 261 | ||
| Pathophysiological findings and pain mechanisms in chronic pancreatitis | 262 | ||
| Calcifying CP | 262 | ||
| Autoimmune pancreatitis | 262 | ||
| Hereditary CP | 263 | ||
| Pathogenesis of pain in chronic pancreatitis | 263 | ||
| Preoperative assessment and investigations | 264 | ||
| Laboratory evaluation | 264 | ||
| Imaging studies | 264 | ||
| Treatment | 264 | ||
| Conservative therapy | 264 | ||
| Endoscopic and interventional treatment | 264 | ||
| Endoscopy | 265 | ||
| Surgical therapy, timing and indications | 265 | ||
| Surgical techniques | 267 | ||
| Selection of the surgical intervention | 267 | ||
| Pancreatico-duodenectomy | 268 | ||
| Distal and total pancreatectomy | 268 | ||
| Partington–Rochelle procedure | 268 | ||
| Longitudinal pancreatico-jejunostomy and cyst drainage | 268 | ||
| Beger procedure | 268 | ||
| Frey procedure | 268 | ||
| Berne procedure | 269 | ||
| Hamburg procedure | 269 | ||
| V-shaped excision | 269 | ||
| Selection of the procedure | 270 | ||
| Salvage procedures | 270 | ||
| Complications of chronic pancreatitis | 270 | ||
| References | 272 | ||
| Chapter 15: Pancreatic adenocarcinoma | 275 | ||
| Introduction | 275 | ||
| Epidemiology | 275 | ||
| Risk factors (see Box 15.1) | 275 | ||
| Smoking | 275 | ||
| Diet and alcohol | 276 | ||
| Occupation | 276 | ||
| Past medical history | 276 | ||
| Hereditary pancreatic cancer | 276 | ||
| Precursor lesions | 277 | ||
| Presentation | 277 | ||
| Investigation | 278 | ||
| Serology | 278 | ||
| Markers | 278 | ||
| Diagnosis | 279 | ||
| Imaging studies | 279 | ||
| Cytology/histology | 280 | ||
| Advanced staging techniques | 280 | ||
| Laparoscopy | 280 | ||
| Pathology | 281 | ||
| Treatment | 281 | ||
| Resection | 281 | ||
| Pancreatico-duodenectomy | 283 | ||
| Pylorus-preserving pancreatico-duodenectomy (PPPDR) | 283 | ||
| Extended lymph node and vascular dissection | 284 | ||
| Distal pancreatectomy | 284 | ||
| Laparoscopic pancreatectomy | 284 | ||
| Total pancreatectomy | 284 | ||
| Central pancreatectomy | 284 | ||
| Surgical palliation | 284 | ||
| Obstructive jaundice | 284 | ||
| Upper GI tract outflow obstruction | 284 | ||
| Adjuvant therapies | 285 | ||
| Neoadjuvant therapy | 285 | ||
| Future areas of interest | 285 | ||
| References | 286 | ||
| Chapter 16: Cystic and neuroendocrine tumours of the pancreas | 289 | ||
| Introduction | 289 | ||
| Intraductal papillary mucinous neoplasms | 289 | ||
| Clinical presentation | 289 | ||
| Investigation | 290 | ||
| Pathology | 291 | ||
| Management | 292 | ||
| Outcome | 294 | ||
| Pancreatic neuroendocrine tumours | 295 | ||
| Clinical presentation | 295 | ||
| Investigations | 295 | ||
| Biochemical | 295 | ||
| Radiology | 295 | ||
| Treatment | 297 | ||
| Metastatic disease | 299 | ||
| Pathology and outcome | 299 | ||
| Other tumours | 299 | ||
| References | 301 | ||
| Chapter 17: Hepatobiliary and pancreatic trauma | 304 | ||
| Introduction | 304 | ||
| Liver trauma | 304 | ||
| Mechanisms of liver injury | 304 | ||
| Classification of liver injury | 305 | ||
| Diagnosis of liver injury | 305 | ||
| Other diagnostic/therapeutic modalities for the assessment and treatment of liver injury | 308 | ||
| Management of liver injury: selection of patients for non-operative management | 308 | ||
| Operative management of liver injury | 309 | ||
| General strategy | 309 | ||
| Choice of incision | 309 | ||
| Intraoperative assessment | 310 | ||
| Perihepatic packing | 311 | ||
| Techniques for surgical haemostasis | 313 | ||
| Resectional debridement | 314 | ||
| Anatomical liver resection | 314 | ||
| Selective ligation of the hepatic artery | 314 | ||
| Management of hepatic venous and retrohepatic caval injury | 314 | ||
| Ex vivo surgery and liver transplantation | 315 | ||
| Complications of liver trauma | 315 | ||
| Complications of non-operative management | 315 | ||
| Postoperative complications after surgery for liver trauma | 315 | ||
| Outcome after liver injury | 316 | ||
| Extrahepatic biliary tract trauma | 316 | ||
| Incidence of biliary injury | 316 | ||
| Classification of biliary injury | 317 | ||
| Presentation and diagnosis of biliary injury | 317 | ||
| Operative management of biliary injury | 318 | ||
| Outcome after biliary injury | 318 | ||
| Pancreatic trauma | 318 | ||
| Mechanisms of pancreatic injury | 318 | ||
| Diagnosis of pancreatic injury | 318 | ||
| Classification of pancreatic injury | 319 | ||
| Initial management of pancreatic injury | 320 | ||
| Operative management of pancreatic injury | 320 | ||
| Complications of pancreatic injury | 321 | ||
| Conclusion | 322 | ||
| References | 323 | ||
| Index | 327 |