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CONTRIBUTORS xi
Katherine A. Morgan, MD, FACS
Associate Professor
Division of Gastrointestinal and Laparoscopic Surgery
Medical University of South Carolina
Charleston, South Carolina
David M. Nagorney, MD
Professor
Section of Hepatobiliary and Pancreatic Surgery
Division of Multispecialty General Surgery
Department of Surgery
Mayo Clinic College of Medicine
Rochester, Minnesota
Attila Nakeeb, MD, FACS
Professor of Surgery
Chief section of HPB Surgery and Surgical Oncology
Indiana University School of Medicine
Indianapolis, Indiana
Alessandro Paniccia, MD
General Surgery Resident
Anschutz Medical Campus
University of Colorado Denver
Denver, Colorado
Timothy M. Pawlik, MD, MPH, PhD, FACS
Professor of Surgery and Oncology
Chief Division of Surgical Oncology
Department of Surgery
Johns Hopkins Hospital
Baltimore, Maryland
Prejesh Philips, MD
Surgical Oncology Fellow
Division of Surgical Oncology
Department of Surgery
University of Louisville
Louisville, Kentucky
Charles H.C. Pilgrim, MBBS (Hons), PhD
Fellow
Department of Surgical Oncology
Medical College of Wisconsin
Milwaukee, Wisconsin
xii CONTRIBUTORS
Henry A. Pitt, MD
Chief Quality Ocer
Temple University Health System
Associate Vice Dean for Clinical Aairs
Temple University School of Medicine
Philadelphia, Pennsylvania
Howard A. Reber, MD
Professor of Surgery
Department of Surgery
David Geen School of Medicine at UCLA
Los Angeles, California
Kumaresan Sandrasegaran, MD
Associate Professor of Radiology
Department of Radiology
Indiana University School of Medicine and Clinical Sciences
Indianapolis, Indiana
Juan M. Sarmiento, MD, FACS
Associate Professor of Surgery
Emory University School of Medicine
Atlanta, Georgia
C. Max Schmidt, MD, PhD, MBA, FACS
Associate Professor of Surgery, Biochemistry, and Molecular Biology
Department of Surgery
Indiana University School of Medicine
Indianapolis, Indiana
Shimul A. Shah, MD, MHCM
Associate Professor of Surgery
Director of Liver Transplantation and Hepatobiliary Surgery
Department of Surgery
University of Cincinnati
Cincinnati, Ohio
Steven M. Strasberg, MD
Pruett Professor of Surgery
Washington University in St. Louis
St. Louis, Missouri
Temel Tirkes, MD
Assistant Professor of Radiology
Department of Radiology
Indiana University School of Medicine
Indianapolis, Indiana
CONTRIBUTORS xiii
Mark J. Truty, MD, MSc
Assistant Professor
Senior Associate Consultant
Section of Hepatobiliary and Pancreatic Surgery
Division of Multispecialty General Surgery
Department of Surgery
Mayo Clinic College of Medicine
Rochester, Minnesota
Ching-Wei D. Tzeng, MD
Hepatopancreatobiliary Surgery Fellow
Department of Surgical Oncology
University of Texas MD Anderson Cancer Center
Houston, Texas
Jean-Nicolas Vauthey, MD
Bessie McGoldrick Professor in Clinical Cancer Research
Chief of Liver Service
Department of Surgical Oncology
e University of Texas MD Anderson Cancer Center
Houston, Texas
Charles M. Vollmer Jr, MD
Associate Professor of Surgery
Department of Surgery
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania
Joshua A. Waters, MD
Resident
Department of Surgery
Indiana University School of Medicine
Indianapolis, Indiana
Nicholas J. Zyromski, MD
Associate Professor
Department of Surgery
Indiana University School of Medicine
Indianapolis, Indiana
xiv
Do we really need another book on HPB surgery? After all, there are
the books by Blumgart and Clavien and all the other abdominal sur-
gery textbooks. Well, the answer for the focused readership of this
Handbook of Hepato-Pancreato-Biliary Surgery is yes—denitely!
While many of these other denite treatises certainly address the
multitude of problems, questions, controversies, and various intri-
cacies of the world of HPB, most all are long tomes, not immedi-
ately and readily readable, and, as always, being the true reference
sources, are more than 2 years behind, and are very daunting to
the reader looking for a concise, up-to-date “review” of relevant
anatomy (not the total Grant’s anatomic detail), acute and chronic
pancreatitis, the spectrum of pancreatic neoplasms (both benign
and malignant), portal hypertension, selected, surgically relevant
biliary and hepatic anatomy, benign and malignant hepatic sur-
gical disorders, and transplantation. Several other focused topics
include minimally invasive HPB procedures, relevant novel tech-
nology being used currently, and even endoscopic treatments of
HPB disorders.
What dierentiates this working handbook are the following
aspects. First, the topics/chapters are carefully selected to address
relevant, real-world topics. Second, the chapters are relatively short,
concise and, most importantly, readable for the medical student, resi-
dent, fellow, and practicing surgeon. Note that the chapters are a bit
more than the classic bare-bones “handbook” and address a topic in
enough depth to provide a comprehensive but not exhaustive discus-
sion. My term for this book would be “comprehensive brevity.” ird,
the book focuses on the surgical practice of HPB, with an emphasis
on diagnosis, treatment, some technique, and complications. Fourth,
the reference list at the end of each chapter oers “selected” read-
ings rather than an exhaustive library. Fifth, the authors are generally
younger, enthusiastic, and more engaging than the more typical clas-
sic greybeards—but all are active clinical practitioners who under-
stand the problems.
So, do we need another book on HPB surgery? I say yes—it is
not a textbook but equally so more than a “pocket handbook” to
FOREWORD
Foreword xv
put out res that arise; best description is comprehensive brevity.
Congratulations to the editors for developing a truly useful, up-to-
date, focused, readable review of current HPB surgery.
Michael G. Sarr, MD
James C. Masson Professor of Surgery
Mayo Clinic
Rochester, Minnesota
xvi
Over the past decade, hepato-pancreato-biliary (HPB) surgery has
emerged as a mature specialty of general surgery. While a signicant
percentage of HPB surgery problems are malignant, HPB surgeons
also treat a large number of benign disease conditions such as acute
and chronic pancreatitis, bile duct injury and benign bile duct stric-
ture, primary sclerosing cholangitis, benign liver lesions, cirrhosis,
and portal hypertension. Diagnosis, evaluation, and both operative
and nonoperative treatment of these patients are often undertaken
in a multidisciplinary format. Surgical decision making in these com-
plex patients is challenging and requires excellent judgment that
comes from experience. Treatment of many HPB conditions (such as
necrotizing pancreatitis, chemotherapy for pancreatic cancer) is an
actively evolving process.
Given this entire picture, the goal of this handbook is to pro-
vide an in-depth yet concise overview of contemporary treatment
of specic HPB surgical conditions. e target audience for the book
includes surgical residents in training, HPB surgery fellows, and gen-
eral surgeons in practice who may not encounter these complex HPB
surgical conditions in day-to-day practice. Others who will likely nd
the text useful include parallel specialty practitioners like gastro-
enterologists, interventional radiologists, and medical oncologists
(i.e. those typically involved in multidisciplinary treatment of HPB
patients) who will gain benet from understanding surgical perspec-
tive of these conditions.
e authors have been selected specically for their expertise
in their chapter’s specic topics. As a whole, the author block rep-
resents substantial academic gravitas in HPB surgery. e depth of
their surgical experience is accessible through clear prose and will
be benecial to all those invested in the care of HPB surgery patients.
PREFACE
xvii
Contributors vi
Foreword xiv
Preface xvi
SECTION I: PANCREAS 1
1 Pancreatic Anatomy and Physiology 2
Somala Mohammed and William E. Fisher
2 Acute Pancreatitis 14
Benjamin N. Gayed and Nicholas J. Zyromski
3 Chronic Pancreatitis 27
Katherine A. Morgan
4 Pancreatic Adenocarcinoma 39
Jashodeep Datta, Jeffrey A. Drebin, and Charles M. Vollmer Jr
5 Pancreatic Cysts Including Intraductal Pancreatic
Mucinous Neoplasm (IPMN) 51
Joshua A. Waters and C. Max Schmidt
6 Pancreatic Neuroendocrine Neoplasms 62
Rebecca A. Busch and Clifford S. Cho
7 Technical Aspects of Pancreatic Surgery 76
Charles H. C. Pilgrim, Douglas B. Evans, and Kathleen K. Christians
8 Minimally Invasive Pancreatic Surgery 89
Michael L. Kendrick
9 Complications of Pancreatic Surgery 99
Timothy R. Donahue and Howard A. Reber
TABLE OF CONTENTS
xviii Table of Contents
SECTION II: LIVER 110
10 Liver Anatomy, Physiology, and Preoperative
Evaluation 111
Ching-Wei D. Tzeng and Jean-Nicolas Vauthey
11 Cirrhosis and Portal Hypertension 126
Rachelle N. Damle and Shimul A. Shah
12 Intraoperative Ultrasound of the Liver, Bile Ducts,
and Pancreas 140
Nicholas J. Zyromski
13 Energy Devices for Parenchymal Transection
in Liver Surgery 157
Prejesh Philips and Robert C.G. Martin II
14 Hepatocellular Carcinoma 169
Mashaal Dhir and Chandrakanth Are
15 Management of Patients with Colorectal Liver
Metastases 178
Danielle A. Bischof and Timothy M. Pawlik
16 Neuroendocrine and Noncolorectal Liver
Metastases 187
Mark J. Truty and David M. Nagorney
17 Benign Liver Tumors 204
Jason B. Liu and Marshall S. Baker
18 Complications of Liver Surgery Including
Postoperative Hepatic Insufciency 221
Ching-Wei D. Tzeng and Thomas A. Aloia
19 Multidisciplinary Approach to Liver Oncology 233
Mary A. Maluccio
20 Laparoscopic Liver Surgery 243
Juan M. Sarmiento and Edward Lin
Table of Contents xix
SECTION III: BILIARY 253
21 Liver and Biliary Anatomy 254
Steven M. Strasberg
22 Infections in Biliary Surgery 271
Massimo Arcerito and Rebecca M. Minter
23 Gallbladder Disease 279
Henry A. Pitt
24 Sphincter of Oddi Dysfunction 300
Evan L. Fogel
25 Common Bile Duct Stones and Exploration 314
Attila Nakeeb
26 Choledochal Cyst 325
Alessandro Paniccia and Barish H. Edil
27 Biliary Malignancies 332
Michael G. House
28 Minimally Invasive Biliary Surgery 345
Eugene P. Ceppa
29 Bile Leak and Bile Duct Injury 354
Jordan P. Bloom and Keith D. Lillemoe
SECTION IV: MULTIDISCIPLINARY HPB CARE 372
30 Liver and Pancreas Transplantation 373
Richard S. Mangus and Jonathan A. Fridell
31 HPB Imaging (Including IR, Ultrasound, MRI,
CT, Nuclear Medicine) 387
Temel Tirkes and Kumaresan Sandrasegaran
32 Endoscopy in HPB Surgery Including ERCP and EUS 397
Wesley D. Leung and Gregory A. Coté
xx Table of Contents
33 HPB Trauma 409
Chad G. Ball
34 Interventional Radiology Support of HPB Surgery 415
Robert L. King and Matthew S. Johnson
Index 433