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Series Editor: T.K. Chattopadhyay
Indian Association ofSurgical
Gastroenterology
GI Surgery Annual
PeushSahni
SujoyPal Editors
GI Surgery
Annual
Volume 26
GI Surgery Annual
Series Editor
T.K.Chattopadhyay
Department of Gastrointestinal Surgery and Liver Transplantation
All India Institute of Medical Sciences
New Delhi
India
This compendium of reviews in gastrointestinal surgery covers topics that are of
contemporary interest to surgeons reecting the popular trends in this eld. Started
by the Indian Association of Surgical Gastroenterology (IASG), the GI Surgery
Annual has covered a journey of over 2 decades which speaks for its relevance and
popularity among general and gastrointestinal surgeons. The reviews contain up-to-
date scientic content of enduring academic interest with each new volume covering
10-12 topics. From 2016 onwards, this Annual turns a new page in its academic
journey by publishing the forthcoming titles with Springer. The editorial control
continues to remain with the IASG and the current editorial board.
The idea of GI Surgery Annual was rst conceived during the annual conference
of Indian Association of Surgical Gastroenterology in 1991 and the First Volume
came into existence in the year 1994, through the efforts of Professor TK
Chattopadhyay and his team of co-editors. Professor TK Chattopadhyay continues
to head the editorial board in his current capacity as Professor Emeritus, AIIMS,
New Delhi.
This Annual is an essential resource for postgraduate and postdoctoral trainees in
surgery and gastrointestinal surgery, for practising surgeons who wish to keep
up-to-date with developments in the eld and for established academic surgeons
as well.
More information about this series at https://link.springer.com/bookseries/15222
Peush Sahni • Sujoy Pal
Editors
GI Surgery Annual
Volume 26
Editor-in-Chief T. K.Chattopadhyay
ISSN 2367-3435 ISSN 2367-3443 (electronic)
GI Surgery Annual
ISBN 978-981-19-0827-9 ISBN 978-981-19-0828-6 (eBook)
https://doi.org/10.1007/978-981-19-0828-6
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore
Pte Ltd. 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
Editors
Peush Sahni
Department of Gastrointestinal Surgery and
Liver Transplantation
All India Institute of Medical Sciences
New Delhi, India
Sujoy Pal
Department of Gastrointestinal Surgery and
Liver Transplantation
All India Institute of Medical Sciences
New Delhi, India
Editor-in-Chief
T.K.Chattopadhyay
Department of Gastrointestinal Surgery
and Liver Transplantation
All India Institute of Medical Sciences
New Delhi,India
v
1 Total Pancreatectomy and Islet Autotransplantation for
Chronic Painful Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Megan Berger, David E. R. Sutherland, and Srinath Chinnakotla
2 Cholangiopancreaticoscopy: A Distinct Diagnostic
and Therapeutic Tool in the Current Era . . . . . . . . . . . . . . . . . . . . . . . 17
Sumit Bhatia, Sukrit Sud, and Randhir Sud
3 Non-cirrhotic Portal Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Vivek Mangla, Shivraj Bahadur Singh, Sujoy Pal, Nabeen Nayak,
and Samiran Nundy
4 Recent Advances in Benign Anorectal Disorders . . . . . . . . . . . . . . . . . 51
Pankaj Garg
5 Progressive Familial Intrahepatic Cholestasis . . . . . . . . . . . . . . . . . . . 95
Rajeev Khanna and Vipul Gautam
6 Training and Credentialing in Multi- Organ Retrieval:
Indian Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Karthik Raichurkar and Sonal Asthana
7 Robotic Surgery in Living Donor Liver Transplantation . . . . . . . . . . 137
V. Sai Tarun, S. T. Binoj, Johns Shaji Matthew, K. Nair,
Jayapal Reddy, Shweta Mallick, Ramachandran Menon,
Dinesh Balakrishnan, G. Unnikrishnan, O. V. Sudheer, Puneet Dhar,
and S. Sudhindran
8 Assessment of Tumour Response to Neoadjuvant Therapy
for the Treatment of Oesophageal Cancer . . . . . . . . . . . . . . . . . . . . . . 147
Carlos S. Cabalag, Jonathan Sivakumar, and Cuong P. Duong
Contents
vi
9 Proton Beam Therapy in Gastrointestinal Cancers: A Paradigm
Shift in Radiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Ashwathy Susan Mathew and Sapna Nangia
10 Immunosuppression in Liver Transplantation . . . . . . . . . . . . . . . . . . . 185
Philip G. Thomas and Ravi Mohanka
11 Advances in Gastrointestinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 221
T. K. Chattopadhyay
Contents
vii
About the Editors
T. K. Chattopadhyay is Professor Emeritus, Department of Gastrointestinal
Surgery and Liver Transplantation, All India Institute of Medical Sciences, New
Delhi. He initiated this series 25years ago and has been the editor-in-chief of this
series since its inception.
PeushSahni is Professor and Head, Department of Gastrointestinal Surgery and
Liver Transplantation, All India Institute of Medical Sciences, New Delhi. He has
been editor since the second volume of this series.
Sujoy Pal is Professor, Department of Gastrointestinal Surgery and Liver
Transplantation, All India Institute of Medical Sciences, New Delhi. He has been
editor of this series since 2005.
1
Chapter 1
Total Pancreatectomy andIslet
Autotransplantation forChronic Painful
Pancreatitis
MeganBerger, DavidE.R.Sutherland, andSrinathChinnakotla
1.1 Introduction
Chronic pancreatitis (CP) is an often painful and debilitating disorder that remains
a challenge for both patients and physicians. It is a rare disorder, with an estimated
incidence of 0.2%–0.6% in the USA [1, 2]. Despite its rarity, the economic impact
of CP is substantial, with total estimated annual healthcare expenditure of US$ 2.6
billion [3]. Frequent hospital admissions, emergency department visits and lost days
of work become a tiresome and expensive way of life for patients with recurrent or
constant pain due to CP.Additionally, if left untreated, many patients will develop
exocrine and endocrine insufciency, and some will go on to develop pancreatic
cancer [4, 5].
The goal of treating CP is to reduce pain and restore quality of life. Initial inter-
ventions are aimed at correcting the mechanical, metabolic, immunological or phar-
macological causes of the disease. Medical options can include antioxidants,
pancreatic enzymes (which both reduce pancreatic stimulation and treat pancreatic
exocrine insufciency), narcotic analgesics and nerve block procedures [6, 7].
Endoscopic interventions may include stone extraction, sphincterotomy, stricture
dilation and stent placement [6, 8]. If medical or endoscopic treatments are not suc-
cessful, patients may be candidates for surgery.
Surgical techniques include partial pancreatic resection (Whipple or distal pan-
createctomy) and drainage procedures such as lateral pancreaticojejunostomy
(Puestow) and variants (Frey, Beger). Patients often have transient pain relief, but
due to the diffuse and progressive nature of CP, pain eventually recurs in up to 50%
M. Berger · D. E. R. Sutherland · S. Chinnakotla (*)
Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
e-mail: chinni@umn.edu
© The Author(s), under exclusive license to Springer Nature Singapore Pte
Ltd. 2022
P. Sahni, S. Pal (eds.), GI Surgery Annual, GI Surgery Annual 26,
https://doi.org/10.1007/978-981-19-0828-6_1
2
of patients [9, 10]. Furthermore, patients frequently continue to develop exocrine
and endocrine insufciency despite surgery [11–14].
A total pancreatectomy (TP) completely removes the root cause of the pain in
chronic pancreatitis. The diseased gland is excised completely, and, unlike with
partial resections or surgical drainage procedures, there is no potential for pancre-
atic duct leakage [15]. Performed in isolation, without preservation of any beta-cell
function, a TP would result in brittle surgically induced diabetes with the added
problem of exocrine pancreatic insufciency. However, when combined with an
intraportal islet autotransplantation (TP-IAT), beta-cell mass can be preserved fol-
lowing TP allowing for insulin secretory capacity and reduction of diabetic symp-
toms and complications.
The world’s rst TP-IAT was performed at the University of Minnesota in 1977
to treat a patient with painful CP [16]. She was pain-free and insulin-independent
for 6years, when she died of unrelated causes [17]. Since then, outcomes following
TP-IAT have been generally favourable, with the vast majority of patients reporting
improved pain and quality of life and many patients requiring little to no insulin to
manage postoperative diabetes. With these favourable outcomes, the procedure has
gained increasing acceptance as a treatment for CP. Presently, there are over 20
centres worldwide with active TP-IAT programmes, and over 1000 of these proce-
dures have been reported in the literature [18–30].
1.2 Evaluation andSelection ofPatients
Due to the extensive nature of the operation and the potential complications of insu-
lin dependence, gastrointestinal dysmotility and post-splenectomy infection,
patients must be selected with considerable care. Criteria for selection of patients
for TP-IAT have evolved over time. Table1.1 summarizes the selection criteria used
at the University of Minnesota. Generally, the patient must meet diagnostic criteria
for chronic or acute relapsing pancreatitis, have pain that is consistent with pancre-
atitis despite previous medical and/or endoscopic procedures and have signicant
impairment in quality of life as a result of pain. The decision to offer a TP-IAT is
made by a multidisciplinary team consisting of gastroenterologists, surgeons, endo-
crinologists, pain specialists, health psychologists, dietitians and nurse coordina-
tors. All patients and families must receive information on the use of pancreatic
enzyme supplementation, the risk of insulin-dependent diabetes, the risk of post-
splenectomy infection, the likelihood of long-term pain relief and any other avail-
able therapeutic options. Patients also undergo psychological and pain evaluations.
Those found to have complex substance abuse issues or having difcult pain man-
agement regimens may be offered additional approaches for anxiety, chemical
dependency and pain management prior to consideration of TP-IAT.
TP-IAT should not be offered to patients with active alcoholism or illegal drug
usage, poorly controlled psychiatric illness or anticipated inability to comply with
the complicated postoperative regimen [31]. Additionally, patients with pancreatic
M. Berger et al.