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Book Details
Abstract
Hepatobiliary and 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.
For this Sixth Edition the authorship team across the series has been expanded to include additional European and World experts, with an increased emphasis on global practice. Throughout all six volumes the contents have been extensively revised in line with recently published evidence. Detailed supportive key references are provided and are also included within the comprehensive list of references in the accompanying ebook. Links to recommended online videos have been added where appropriate.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within the major sub-specialties of general surgery.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
This edition of Hepatobiliary and Pancreatic Surgery includes new chapters on pancreas, islet and liver transplantation. The text includes new treatment options such as radioembolization, antiangiogenics and ALPPS, the latest guidelines on HCC and colorectal liver metastases management with recent evidence on treatment of biliary tract cancer, pancreatic cystic lesions and complicated acute pancreatitis. Over half of the chapters have been re-written by new authors thus ensuring that this edition is fresh, relevant and incorporates the latest developments and most up-to-date evidence base.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Hepatobiliary and Pancreatic Surgery: A Companion to Specialist Surgical Practice | i | ||
| Copyright | ii | ||
| Contents | iii | ||
| Series Editors' preface | v | ||
| Editors' preface | vii | ||
| Acknowledgements | vii | ||
| Evidence-based practice in surgery | ix | ||
| Contributors | xi | ||
| 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 resection | 2 | ||
| Chronic liver failure | 3 | ||
| Metabolic liver function | 4 | ||
| Why do patients die from liver failure? | 4 | ||
| Assessment of the liver | 4 | ||
| Measuring liver volume | 4 | ||
| Blood tests of liver function | 4 | ||
| Tests of liver function measuring substance clearance | 6 | ||
| Indocyanine green (ICG) | 6 | ||
| Hepatobiliary scintigraphy and SPECT | 6 | ||
| Lidocaine (MEG-X) | 6 | ||
| Aminopyrine breath test | 7 | ||
| Urea synthesis | 7 | ||
| Glutathione synthesis | 7 | ||
| Measuring liver blood flow | 7 | ||
| Effect of major liver resection on hepatic blood flow | 8 | ||
| Assessment of innate immunity | 8 | ||
| Liver regeneration | 9 | ||
| Molecular signals for hepatic regeneration | 9 | ||
| Cell populations involved in liver regeneration | 10 | ||
| Consequences of surgery | 10 | ||
| Small-for-size syndrome | 11 | ||
| Hepatic steatosis | 11 | ||
| Assessment of steatosis | 11 | ||
| Chemotherapy-induced liver changes | 12 | ||
| Portal vein embolisation | 12 | ||
| Technique | 12 | ||
| Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS procedure) | 13 | ||
| Supporting the failing liver | 13 | ||
| N-Acetyl cysteine | 13 | ||
| Nutritional support in liver failure | 13 | ||
| Extracorporeal liver support | 13 | ||
| Artificial liver support | 14 | ||
| Bioartificial liver systems | 14 | ||
| Liver transplantation | 14 | ||
| Cell therapy for liver failure: general principles | 15 | ||
| Haemopoetic stem cell therapy for liver disease in humans | 15 | ||
| Future developments | 15 | ||
| Key references | 16 | ||
| 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 | 19 | ||
| Surgical anatomy for liver resections | 21 | ||
| Hepatic arteries and liver resections | 21 | ||
| Bile ducts and liver resections | 23 | ||
| Prevailing pattern and important variations of bile ducts draining the right hemiliver | 23 | ||
| Prevailing pattern and important variations of bile ducts draining the left hemiliver | 23 | ||
| Prevailing pattern of bile ducts draining the caudate lobe (Sg1) | 25 | ||
| Portal veins and liver resections | 25 | ||
| Ramification of the left portal vein | 25 | ||
| Hepatic veins and liver resection (Fig. 2.14) | 26 | ||
| Liver capsule, attachments and the plate system | 27 | ||
| Liver volume and regeneration | 29 | ||
| Gallbladder and extrahepatic bile ducts | 29 | ||
| Gallbladder | 29 | ||
| Agenesis of the gallbladder | 30 | ||
| Double gallbladder | 30 | ||
| Cystic duct | 30 | ||
| Cystic artery | 30 | ||
| Extrahepatic bile ducts | 32 | ||
| Anomalies of extrahepatic bile ducts | 32 | ||
| Extrahepatic arteries | 32 | ||
| Blood supply of bile ducts | 32 | ||
| Pancreas | 34 | ||
| Embryological development of the pancreas | 34 | ||
| Anatomical structure and functions of the pancreas | 34 | ||
| Pancreatic ducts | 35 | ||
| Blood supply of the pancreas | 36 | ||
| Lymphatics of the pancreas | 37 | ||
| Anatomical relations and ligaments of the pancreas | 38 | ||
| Innervation of the pancreas | 39 | ||
| Key references | 40 | ||
| 3 Staging and assessment of hepatobiliary malignancies | 41 | ||
| Introduction | 41 | ||
| Colorectal liver metastases | 41 | ||
| Transabdominal ultrasound | 41 | ||
| Computed tomography and magnetic resonance imaging | 41 | ||
| Positron emission tomography | 42 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 43 | ||
| Staging and assessment of resectability | 43 | ||
| Hepatocellular carcinoma | 44 | ||
| Transabdominal ultrasound | 44 | ||
| Computed tomography and magnetic resonance imaging | 44 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 45 | ||
| Staging and assessment of resectability | 45 | ||
| Pancreatic and periampullary carcinoma | 46 | ||
| Transabdominal ultrasound | 46 | ||
| Computed tomography and magnetic resonance imaging | 47 | ||
| Endoscopic retrograde cholangiopancreatography | 47 | ||
| Endoscopic ultrasound (EUS) | 48 | ||
| Positron emission tomography | 48 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 48 | ||
| Staging and assessment of resectability | 49 | ||
| Proximal bile duct tumours | 52 | ||
| Transabdominal ultrasound | 53 | ||
| Computed tomography and magnetic resonance imaging | 53 | ||
| Endoscopic retrograde cholangiopancreatography | 53 | ||
| Positron emission tomography | 53 | ||
| Diagnostic laparoscopy and laparoscopic ultrasound | 53 | ||
| Staging and assessment of resectability | 54 | ||
| Key references | 57 | ||
| 4 Benign liver lesions | 59 | ||
| Introduction | 59 | ||
| Hepatocellular liver lesions | 59 | ||
| Focal nodular hyperplasia (FNH) | 59 | ||
| General | 59 | ||
| Clinical presentation | 59 | ||
| Diagnosis | 60 | ||
| Pathology | 61 | ||
| Management | 61 | ||
| Hepatocellular adenoma | 61 | ||
| General | 61 | ||
| Clinical presentation | 61 | ||
| Diagnosis | 61 | ||
| Pathology | 63 | ||
| Management | 63 | ||
| Nodular regenerative hyperplasia | 64 | ||
| Cholangiocellular liver lesions | 64 | ||
| Simple cysts of the liver | 64 | ||
| General | 64 | ||
| Clinical presentation | 64 | ||
| Diagnosis | 64 | ||
| Management | 65 | ||
| Polycystic liver disease | 65 | ||
| General | 65 | ||
| Clinical presentation | 66 | ||
| Management | 66 | ||
| Cystadenoma | 66 | ||
| General | 66 | ||
| Clinical presentation | 67 | ||
| Imaging | 67 | ||
| Management | 67 | ||
| Bile duct adenoma | 67 | ||
| Intraductal papillary neoplasm of the bile duct | 67 | ||
| Mesenchymal liver lesions | 68 | ||
| Haemangiomata | 68 | ||
| General | 68 | ||
| Clinical presentation | 68 | ||
| Diagnosis | 68 | ||
| Pathology | 69 | ||
| Management | 69 | ||
| Hepatic lipoma and angiolipoma | 70 | ||
| Inflammatory liver lesions | 70 | ||
| Pyogenic liver abscess | 70 | ||
| General | 70 | ||
| Clinical presentation | 70 | ||
| Diagnosis | 70 | ||
| Management | 70 | ||
| Amoebic liver abscess | 71 | ||
| General | 71 | ||
| Clinical presentation | 71 | ||
| Management | 72 | ||
| Hydatid cysts | 72 | ||
| General | 72 | ||
| Clinical presentation | 72 | ||
| Diagnosis | 73 | ||
| Management | 73 | ||
| Other liver lesions | 73 | ||
| Key references | 74 | ||
| 5 Primary malignant tumours of the liver | 76 | ||
| Hepatocellular carcinoma | 76 | ||
| Incidence of HCC | 76 | ||
| Risk factors for HCC | 77 | ||
| Cirrhosis vs no underlying liver disease | 77 | ||
| HBV infection | 77 | ||
| HCV infection | 78 | ||
| Human immunodeficiency virus (HIV) infection | 78 | ||
| Other viral infections | 78 | ||
| Alcohol | 78 | ||
| Non-alcoholic fatty liver disease (NAFLD) | 78 | ||
| Hereditary haemochromatosis | 79 | ||
| Cirrhosis of other aetiologies | 79 | ||
| Aflatoxin | 79 | ||
| Metabolic liver diseases and HCC | 80 | ||
| Adenoma, contraceptives and androgens | 80 | ||
| Pathology of HCC and of nodular lesions in chronic liver disease | 80 | ||
| Clinical presentation | 82 | ||
| Liver function tests and tumour markers | 82 | ||
| Liver function tests | 82 | ||
| Serum tumour markers | 82 | ||
| Alpha-fetoprotein | 82 | ||
| Others serum tumour markers | 82 | ||
| Morphological studies | 83 | ||
| Ultrasound | 83 | ||
| Computed tomography | 83 | ||
| Magnetic resonance imaging | 84 | ||
| Contrast-enhanced ultrasound | 84 | ||
| Other imaging | 85 | ||
| Angiography | 85 | ||
| Positron emission tomography | 85 | ||
| Accuracy of imaging techniques | 85 | ||
| Requirement for and reliability of histological study | 85 | ||
| Diagnosis of HCC | 86 | ||
| Natural history of HCC and staging systems | 86 | ||
| Screening for HCC | 88 | ||
| Treatment options | 88 | ||
| HCC in normal liver | 89 | ||
| Liver resection of HCC in cirrhotic patients | 89 | ||
| Liver resection | 89 | ||
| Main limitations | 89 | ||
| Risk of surgery and patient selection | 89 | ||
| Technique | 90 | ||
| Outcome after resection | 90 | ||
| Treatment of recurrence | 90 | ||
| Liver transplantation (LT) | 91 | ||
| Rationale | 91 | ||
| Patient selection | 91 | ||
| Treatment on the waiting list | 91 | ||
| Transarterial chemoembolisation (TACE) | 92 | ||
| Technique | 92 | ||
| Contraindications | 92 | ||
| Morbidity and mortality | 92 | ||
| Monitoring | 92 | ||
| Efficacy | 93 | ||
| Percutaneous local ablative therapy | 93 | ||
| Technique | 93 | ||
| Advantages and drawbacks | 93 | ||
| Contraindications and limitations | 94 | ||
| Methods and margins | 94 | ||
| Indication | 94 | ||
| Other palliative treatments | 94 | ||
| Conventional systemic chemotherapy | 94 | ||
| Anti-angiogenic targeted therapies | 95 | ||
| Radioembolisation | 95 | ||
| Other treatments | 95 | ||
| Defining a treatment strategy | 95 | ||
| Uncomplicated HCC associated with chronic liver disease | 95 | ||
| Treatment of complicated HCC | 96 | ||
| Fibrolamellar carcinoma (FLC) | 96 | ||
| Intrahepatic cholangiocarcinoma (ICCA) | 97 | ||
| Incidence | 97 | ||
| Risk factors | 97 | ||
| Classification and staging | 97 | ||
| Pathology and progression analysis | 97 | ||
| Clinical presentation and laboratory tests | 98 | ||
| Imaging studies | 98 | ||
| Diagnosis | 98 | ||
| Treatment | 98 | ||
| Epithelioid haemangioendothelioma (EHE) | 99 | ||
| Angiosarcoma | 100 | ||
| Primary hepatic lymphoma | 101 | ||
| Key references | 103 | ||
| 6 Colorectal liver metastases | 104 | ||
| Introduction | 104 | ||
| Diagnosis | 104 | ||
| Surgical resection | 108 | ||
| Patient selection | 108 | ||
| Issues in management of CRLM | 109 | ||
| Current practice for margin status | 109 | ||
| Role of the FLR in resection of CRLM | 109 | ||
| Extrahepatic metastatic disease and role of surgery | 109 | ||
| Role of diagnostic laparoscopy before CRLM resection | 110 | ||
| Current surgical strategy in management of patients with bilateral CRLM | 110 | ||
| Preoperative chemotherapy | 111 | ||
| Resectable metachronous CRLM | 111 | ||
| Unresectable metachronous CRLM | 113 | ||
| Synchronous CRLM | 113 | ||
| Adjuvant chemotherapy | 114 | ||
| Systemic chemotherapy | 114 | ||
| Hepatic artery infusion (HAI) chemotherapy | 114 | ||
| Portal vein infusion chemotherapy | 114 | ||
| Survival and prognosis | 114 | ||
| Surveillance | 116 | ||
| Management of unresectable CRLM | 116 | ||
| Chemotherapy | 116 | ||
| Systemic chemotherapy | 116 | ||
| HAI chemotherapy | 117 | ||
| Ablation therapy | 117 | ||
| Radiation therapy | 118 | ||
| Conclusion | 118 | ||
| Key references | 119 | ||
| 7 Non-colorectal hepatic metastases | 121 | ||
| Introduction | 121 | ||
| Pathophysiology and molecular basis of liver metastases | 122 | ||
| Clinical approach to non-colorectal liver metastases | 123 | ||
| Treatment strategies | 123 | ||
| Management of liver metastases by primary tumour | 124 | ||
| Neuroendocrine tumours | 124 | ||
| Gastrointestinal stromal tumours | 126 | ||
| Breast cancer | 127 | ||
| Ovarian cancer | 127 | ||
| Renal cell carcinoma | 128 | ||
| Melanoma | 128 | ||
| Non-colorectal gastrointestinal adenocarcinoma | 129 | ||
| Oesophagus | 129 | ||
| Stomach | 129 | ||
| Small bowel | 130 | ||
| Pancreas | 130 | ||
| Testicular cancer | 131 | ||
| Urothelial cancer | 131 | ||
| Lung cancer | 131 | ||
| Adrenocortical tumours | 131 | ||
| Endometrial cancer | 131 | ||
| Conclusion | 132 | ||
| 8 Portal hypertension and liver transplantation | 133 | ||
| Introduction | 133 | ||
| Aetiology | 133 | ||
| Definition of portal hypertension | 134 | ||
| Pathophysiology | 135 | ||
| Natural history | 135 | ||
| Severity of liver disease | 135 | ||
| Presentation | 136 | ||
| Evaluation | 137 | ||
| Management | 137 | ||
| First line therapy options | 137 | ||
| Pharmacotherapy | 137 | ||
| Endoscopy | 138 | ||
| Second-line therapy options | 138 | ||
| Balloon tamponade | 138 | ||
| TIPSS (Transjugular intrahepatic portosystemic shunt) | 139 | ||
| Surgical shunts (Fig. 8.2) | 139 | ||
| Clinical scenarios | 141 | ||
| Prevention of variceal bleeding | 141 | ||
| Treatment for bleeding varices | 142 | ||
| Gastric varices | 143 | ||
| Portal hypertensive gastropathy | 143 | ||
| Segmental portal hypertension | 143 | ||
| Budd–Chiari syndrome | 144 | ||
| Portal vein thrombosis | 145 | ||
| Prevention of re-bleeds | 145 | ||
| Liver transplantation | 146 | ||
| Indication | 146 | ||
| Donor hepatectomy | 147 | ||
| Recipient hepatectomy | 148 | ||
| Implant | 148 | ||
| Complications | 148 | ||
| Immunosuppression | 149 | ||
| Results | 149 | ||
| Key references | 150 | ||
| 9 Pancreas and islet transplantation | 151 | ||
| Introduction | 151 | ||
| Pancreas transplantation | 151 | ||
| History of pancreas transplantation | 151 | ||
| Indications for pancreas transplantation | 152 | ||
| Pancreas retrieval operation | 152 | ||
| The pancreas transplant operation | 153 | ||
| General considerations | 153 | ||
| Management of exocrine secretions | 154 | ||
| Management of the venous drainage | 154 | ||
| Immunosuppression in pancreas transplantation | 155 | ||
| Diagnosis and management of acute rejection following pancreas transplantation | 155 | ||
| Complications of pancreas transplantation | 156 | ||
| Vascular complications | 157 | ||
| Thrombosis | 157 | ||
| Haemorrhage | 157 | ||
| Infective complications | 157 | ||
| Allograft pancreatitis | 158 | ||
| Complications specific to bladder drainage | 158 | ||
| Outcome following pancreas transplantation | 158 | ||
| Factors influencing pancreas transplantation outcome | 158 | ||
| Recipient age | 158 | ||
| Re-transplantation | 158 | ||
| HLA matching | 158 | ||
| Management of exocrine secretions and management of venous drainage | 158 | ||
| Immunosuppression | 158 | ||
| Donor factors | 159 | ||
| Long-term outlook following pancreas transplantation | 159 | ||
| Pancreas transplantation and life expectancy | 159 | ||
| Influence of pancreas transplantation on diabetic complications | 160 | ||
| Nephropathy | 160 | ||
| Retinopathy | 160 | ||
| Neuropathy | 160 | ||
| Cardiovascular disease | 160 | ||
| Islet transplantation | 160 | ||
| Patient selection and assessment | 161 | ||
| Islet isolation | 162 | ||
| The islet transplant | 163 | ||
| Immunosuppression and outcomes | 164 | ||
| Barriers to long-term function | 165 | ||
| Islets as a cell therapy | 165 | ||
| Key references | 167 | ||
| 10 The spleen and adrenal glands | 168 | ||
| Introduction | 168 | ||
| Anatomy and embryology | 168 | ||
| Indications for splenectomy | 170 | ||
| Trauma | 170 | ||
| Haematological | 170 | ||
| Neoplastic | 171 | ||
| Infectious | 171 | ||
| Splenectomy | 171 | ||
| Open | 171 | ||
| Laparoscopic | 172 | ||
| Partial splenectomy | 172 | ||
| Splenectomy vaccinations | 172 | ||
| Adrenal | 173 | ||
| Introduction | 173 | ||
| Anatomy and embryology | 173 | ||
| Physiology | 174 | ||
| Indications for adrenalectomy | 175 | ||
| Aldosteronoma (primary hyperaldosteronism) | 175 | ||
| Cushing syndrome | 175 | ||
| Pheochromocytoma | 176 | ||
| Primary adrenocortical carcinoma | 176 | ||
| Incidentaloma | 177 | ||
| Secondary adrenal metastases | 177 | ||
| Adrenalectomy | 177 | ||
| Open | 177 | ||
| Left | 177 | ||
| Right | 177 | ||
| Laparoscopic | 178 | ||
| Left | 178 | ||
| Right | 178 | ||
| Key references | 179 | ||
| 11 Gallstones | 180 | ||
| Introduction | 180 | ||
| Pathogenesis of gallstones | 180 | ||
| Risk factors | 181 | ||
| Pigment stones | 183 | ||
| Presentation | 183 | ||
| Biliary pain | 183 | ||
| Acute cholecystitis | 184 | ||
| Common bile duct stones | 185 | ||
| Acute pancreatitis | 186 | ||
| Mirizzi syndrome | 186 | ||
| Intrahepatic stone disease | 186 | ||
| Management of gallstones | 186 | ||
| Conservative | 186 | ||
| Non-operative management | 187 | ||
| Cholecystectomy | 188 | ||
| Intraoperative bile duct imaging and prevention of bile duct injury | 189 | ||
| Acute cholecystitis | 190 | ||
| Prophylactic cholecystectomy | 191 | ||
| Bile duct stones | 191 | ||
| ERCP | 191 | ||
| Surgical bile duct exploration | 192 | ||
| Approaches to the management of simultaneous CBD and gallbladder stones | 192 | ||
| Approaches to abnormal LFTs prior to LC | 193 | ||
| Management of specific scenarios | 194 | ||
| Gallstone ileus | 194 | ||
| Mirizzi syndrome | 196 | ||
| Postcholecystectomy complications – identification and management | 196 | ||
| Early presentation | 196 | ||
| Delayed presentation | 197 | ||
| Bile duct injury | 197 | ||
| Postoperative problems (chronic) | 197 | ||
| Gallstones and cancer | 198 | ||
| Porcelain gallbladder | 199 | ||
| Other diseases of the gallbladder | 199 | ||
| Acute acalculous cholecystitis | 199 | ||
| Primary infections of the gallbladder | 199 | ||
| Chronic acalculous cholecystitis | 199 | ||
| Gallbladder disease in childhood | 200 | ||
| Adenomyomatosis | 200 | ||
| Key references | 200 | ||
| 12 Benign biliary tract diseases | 201 | ||
| Introduction | 201 | ||
| Congenital anomalies | 201 | ||
| Biliary atresia | 201 | ||
| Choledochal cysts | 201 | ||
| Classification | 202 | ||
| Risk of malignancy | 202 | ||
| Management | 202 | ||
| Special operative techniques | 203 | ||
| Iatrogenic biliary injury | 204 | ||
| Aetiology | 204 | ||
| Techniques to avoid injury | 204 | ||
| Classification | 206 | ||
| Presentation | 206 | ||
| Management | 207 | ||
| Intraoperative recognition | 207 | ||
| Postoperative recognition: biliary fistula | 207 | ||
| Postoperative recognition: biliary obstruction | 209 | ||
| The timing of repair | 210 | ||
| Early repair | 210 | ||
| Delayed repair | 210 | ||
| Associated vascular injury | 210 | ||
| Further imaging | 212 | ||
| Operative techniques | 212 | ||
| Management of complications related to repair | 213 | ||
| Revisional surgery | 213 | ||
| Liver resection and transplantation | 213 | ||
| Prognosis | 213 | ||
| Success of repair | 213 | ||
| Survival | 214 | ||
| Quality of life | 214 | ||
| Associated malignancy | 214 | ||
| Benign biliary strictures | 214 | ||
| Mirizzi's syndrome – see Chapter 11 | 214 | ||
| Hepatolithiasis – see Chapter 11 | 214 | ||
| Parasitic infestation causing jaundice | 214 | ||
| Liver flukes (trematodes) | 214 | ||
| Echinococcus | 215 | ||
| Treatment | 215 | ||
| Ascaris lumbricoides | 215 | ||
| HIV/AIDS-associated cholangiopathy | 215 | ||
| Biliary strictures imitating malignancy | 216 | ||
| Primary sclerosing cholangitis | 216 | ||
| Aetiology | 216 | ||
| Presentation | 216 | ||
| Investigation | 216 | ||
| Management | 216 | ||
| Exclusion of associated malignant stricture | 216 | ||
| Immunoglobulin G4 (IgG4)-related disease | 217 | ||
| Autoimmune pancreatitis | 217 | ||
| IgG4-related sclerosing cholangitis | 217 | ||
| Treatment | 217 | ||
| Functional biliary disorders | 218 | ||
| Key references | 218 | ||
| 13 Malignant lesions of the biliary tract | 220 | ||
| Introduction | 220 | ||
| Cholangiocarcinoma | 220 | ||
| Epidemiology | 220 | ||
| Risk factors | 221 | ||
| Primary sclerosing cholangitis | 221 | ||
| Congenital cysts | 221 | ||
| Hepatolithiasis | 221 | ||
| Parasitic infection | 221 | ||
| Viral hepatitis and cirrhosis | 221 | ||
| Chemical exposure | 221 | ||
| Classification/histopathology | 221 | ||
| Clinical presentation | 222 | ||
| Diagnostic assessment | 222 | ||
| Radiological investigation | 222 | ||
| Computed tomography | 223 | ||
| Duplex ultrasonography | 224 | ||
| Magnetic resonance cholangiopancreatography (MRCP) | 224 | ||
| Positron emission tomography | 225 | ||
| Invasive modalities | 225 | ||
| Direct cholangiography | 225 | ||
| Endoscopy | 225 | ||
| Cytology | 225 | ||
| Choledochoscopy | 226 | ||
| SpyGlass endoscopy | 226 | ||
| Serum markers | 226 | ||
| Staging | 226 | ||
| Hilar cholangiocarcinoma | 226 | ||
| Extrahepatic cholangiocarcinoma | 227 | ||
| Intrahepatic cholangiocarcinoma | 228 | ||
| Management | 228 | ||
| Preoperative tissue diagnosis | 228 | ||
| Preoperative biliary drainage | 228 | ||
| Neoadjuvant therapy | 229 | ||
| Portal vein embolisation | 229 | ||
| General operative principles | 229 | ||
| Diagnostic laparoscopy | 230 | ||
| Margin-negative resection | 230 | ||
| Portal lymphadenectomy | 231 | ||
| Caudate lobectomy | 232 | ||
| No touch technique | 232 | ||
| Postoperative oncological outcomes | 233 | ||
| Technical aspects of resection | 233 | ||
| Adjuvant therapy | 233 | ||
| Transplantation | 234 | ||
| Palliative therapy | 234 | ||
| Intrahepatic biliary-enteric bypass | 234 | ||
| Systemic therapy | 234 | ||
| Novel agents | 235 | ||
| Regional chemotherapy/hepatic arterial infusion | 235 | ||
| Y-90 radioembolisation | 235 | ||
| Gallbladder cancer | 236 | ||
| Epidemiology/aetiology | 236 | ||
| Clinical presentation and diagnosis | 237 | ||
| Histopathology and staging | 237 | ||
| Radiological assessment | 238 | ||
| Obstructive jaundice | 239 | ||
| General operative principles | 239 | ||
| Margin-negative resection | 239 | ||
| Portal lymphadenectomy | 240 | ||
| T1/T2 tumours | 240 | ||
| Extended resections | 240 | ||
| Unsuspected malignancy at exploration | 240 | ||
| Malignancy diagnosed post-cholecystectomy | 241 | ||
| Adjuvant therapy | 241 | ||
| 14 Complicated acute pancreatitis | 244 | ||
| Introduction | 244 | ||
| Initial management | 244 | ||
| Key concepts | 244 | ||
| Definitions and terminology in acute pancreatitis | 244 | ||
| Acute peripancreatic fluid collection (APFC) | 245 | ||
| Pancreatic pseudocyst | 245 | ||
| Necrosis | 245 | ||
| Acute necrotic collection | 245 | ||
| Walled-off necrosis | 245 | ||
| Sterile and infected collections | 246 | ||
| Clinical patterns and complications | 246 | ||
| Early phase complications (<4 weeks) | 246 | ||
| Systemic complications | 246 | ||
| Organ failure | 246 | ||
| Intra-abdominal hypertension (IAH) | 246 | ||
| The role of ERCP in acute pancreatitis | 247 | ||
| Early haemorrhage | 247 | ||
| Colonic ischaemia | 247 | ||
| Late complications (>4 weeks) | 247 | ||
| Management of collections associated with acute pancreatitis | 247 | ||
| Management of necrosis | 247 | ||
| Indications for intervention | 248 | ||
| Sepsis control in an infected acute necrotic or walled-off collection (early phase, 2–6 weeks) | 249 | ||
| Methods of sepsis control | 249 | ||
| Minimally invasive approaches to infected necrosis | 249 | ||
| Percutaneous drainage | 249 | ||
| Minimally invasive surgery | 249 | ||
| Endoscopic necrosectomy | 250 | ||
| Open laparotomy/debridement | 250 | ||
| Retrocolic/perineal/mesenteric necrosis | 251 | ||
| Nutritional support | 251 | ||
| Nutritional delivery in the patient with acute pancreatitis | 251 | ||
| Disease modulation through content or mode of delivery | 251 | ||
| Delayed gastric emptying/gastric outlet obstruction | 252 | ||
| Management of acute phase complications | 252 | ||
| Haemorrhage | 252 | ||
| Venous thrombosis | 253 | ||
| Enteric fistula | 253 | ||
| Biliary obstruction | 254 | ||
| Long-term complications | 254 | ||
| Pancreatic duct fistula | 254 | ||
| Pancreatic duct stricture | 254 | ||
| Disconnected duct syndrome | 254 | ||
| Late extrahepatic biliary stricture | 254 | ||
| Portal and splenic vein thrombosis and cavernous transformation | 255 | ||
| Key references | 256 | ||
| 15 Chronic pancreatitis | 257 | ||
| Introduction | 257 | ||
| Definition | 257 | ||
| Classification of chronic pancreatitis | 257 | ||
| Incidence | 258 | ||
| Aetiology | 258 | ||
| Pathogenesis of pain in chronic pancreatitis | 258 | ||
| Clinical presentations | 259 | ||
| Acute presentation of chronic pancreatitis | 259 | ||
| Chronic presentation of chronic pancreatitis | 259 | ||
| Index presentation with complications of chronic pancreatitis | 259 | ||
| Asymptomatic incidental finding | 259 | ||
| Practical differential diagnoses in chronic pancreatitis | 259 | ||
| Pancreatic cancer | 259 | ||
| Autoimmune pancreatitis | 260 | ||
| Intraductal papillary mucinous neoplasm (IPMN) | 260 | ||
| Clinical course | 260 | ||
| Baseline assessment of a patient with suspected chronic pancreatitis | 260 | ||
| Medical management of chronic pancreatitis | 261 | ||
| Analgesia | 261 | ||
| Alcohol avoidance | 261 | ||
| Smoking cessation | 261 | ||
| Exocrine replacement therapy | 261 | ||
| Medications of unproven benefit | 262 | ||
| Endoscopic management of chronic pancreatitis | 262 | ||
| Endoscopic drainage compared to surgical drainage of the main pancreatic duct | 262 | ||
| Endoscopic drainage/stenting of the main pancreatic duct | 262 | ||
| Endoscopic coeliac plexus block | 262 | ||
| Endoscopic treatment of complications of chronic pancreatitis | 263 | ||
| Surgical management of chronic pancreatitis | 264 | ||
| Indications for surgery | 264 | ||
| Case selection for surgery in chronic pancreatitis | 264 | ||
| Timing of surgery | 264 | ||
| Preparation for surgery | 264 | ||
| Selection of surgical procedure | 264 | ||
| Surgery for chronic pancreatitis in patients with a pancreatic head mass | 264 | ||
| Surgery for chronic pancreatitis in patients with a dilated main pancreatic duct without pancreatic head mass | 265 | ||
| Indications for total pancreatectomy for chronic pancreatitis | 265 | ||
| Surgical management of small-duct chronic pancreatitis | 266 | ||
| Complications of longstanding chronic pancreatitis | 266 | ||
| Biliary stricture | 267 | ||
| Duodenal stenosis | 267 | ||
| Pancreatic ascites | 267 | ||
| Pseudocyst complicating chronic pancreatitis | 267 | ||
| False aneurysm of visceral vessels | 267 | ||
| Extrahepatic portal hypertension | 267 | ||
| Pancreatic cancer complicating chronic pancreatitis | 268 | ||
| Key references | 269 | ||
| 16 Pancreatic adenocarcinoma | 270 | ||
| Introduction | 270 | ||
| Epidemiology | 270 | ||
| Risk factors (see Box 16.1) | 270 | ||
| Smoking | 270 | ||
| Diet and alcohol | 270 | ||
| Occupation | 271 | ||
| Past medical history | 271 | ||
| Hereditary pancreatic cancer | 271 | ||
| Precursor lesions | 272 | ||
| Presentation | 273 | ||
| Investigation | 273 | ||
| Serology | 273 | ||
| Markers | 274 | ||
| Diagnosis | 274 | ||
| Imaging studies | 274 | ||
| Cytology/histology | 275 | ||
| Advanced staging techniques | 275 | ||
| Laparoscopy | 275 | ||
| Pathology | 277 | ||
| Treatment | 277 | ||
| Resection | 277 | ||
| Pancreatico-duodenectomy | 278 | ||
| Pylorus-preserving pancreatico-duodenectomy (PPPDR) | 280 | ||
| Extended lymph node and vascular dissection | 280 | ||
| Distal pancreatectomy | 281 | ||
| Laparoscopic pancreatectomy | 281 | ||
| Total pancreatectomy | 281 | ||
| Central pancreatectomy | 281 | ||
| Surgical palliation | 281 | ||
| Obstructive jaundice | 281 | ||
| Upper GI tract outflow obstruction | 281 | ||
| Adjuvant therapies | 282 | ||
| Neoadjuvant therapy | 282 | ||
| Future areas of interest | 282 | ||
| Key references | 283 | ||
| 17 Cystic and neuroendocrine tumours of the pancreas | 286 | ||
| Introduction | 286 | ||
| Intraductal papillary mucinous neoplasms | 286 | ||
| Clinical presentation | 286 | ||
| Investigation | 287 | ||
| Pathology | 288 | ||
| Management | 289 | ||
| Outcome | 291 | ||
| Pancreatic neuroendocrine tumours | 292 | ||
| Clinical presentation | 292 | ||
| Investigations | 292 | ||
| Biochemical | 292 | ||
| Radiology | 292 | ||
| Treatment | 294 | ||
| Metastatic disease | 295 | ||
| Pathology and outcome | 296 | ||
| Other tumours | 296 | ||
| Key references | 298 | ||
| 18 Hepatobiliary and pancreatic trauma | 299 | ||
| Introduction | 299 | ||
| Liver trauma | 299 | ||
| Mechanisms of liver injury | 299 | ||
| Classification of liver injury | 300 | ||
| Diagnosis of liver injury | 301 | ||
| Other diagnostic/therapeutic modalities for the assessment and treatment of liver injury | 303 | ||
| Management of liver injury: selection of patients for non-operative management | 303 | ||
| Operative management of liver injury | 304 | ||
| General strategy | 304 | ||
| Theatre set-up, patient positioning and choice of incision | 304 | ||
| Initial manoeuvres and intraoperative assessment | 305 | ||
| Perihepatic packing | 305 | ||
| The Pringle manoeuvre | 306 | ||
| Techniques for hepatic surgical haemostasis | 307 | ||
| Resectional debridement | 307 | ||
| Anatomical liver resection | 308 | ||
| Management of hepatic venous and retrohepatic caval injury | 309 | ||
| Ex vivo surgery and liver transplantation | 309 | ||
| Complications of liver trauma | 310 | ||
| Complications of non-operative management | 310 | ||
| Postoperative complications after surgery for liver trauma | 310 | ||
| Outcome after liver injury | 310 | ||
| Extrahepatic biliary tract trauma | 311 | ||
| Incidence of biliary injury | 311 | ||
| Classification of biliary injury | 311 | ||
| Presentation and diagnosis of Łbiliary injury | 312 | ||
| Operative management of biliary injury | 312 | ||
| Outcome after biliary injury | 312 | ||
| Pancreatic trauma | 312 | ||
| Mechanisms of pancreatic injury | 313 | ||
| Diagnosis of pancreatic injury | 313 | ||
| Classification of pancreatic injury | 313 | ||
| Initial management of pancreatic injury | 314 | ||
| Operative management of Łpancreatic injury | 314 | ||
| Complications of pancreatic injury | 316 | ||
| Conclusion | 316 | ||
| Key references | 318 | ||
| Index | 319 |