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- •Contents
- •List of figures
- •List of tables
- •Pancreatitis
- •Pancreatic fistulae
- •Pancreatic tumours
- •Trauma
- •Trauma to the third and fourth part of the duodenum
- •Benign bleeding
- •Malignant bleeding
- •Perforated duodenal ulcer
- •Duodenal tumours
- •Benign tumours
- •Duodenal invasion from external malignancy
- •Duodenal bleeding
- •Duodenal diverticula
- •Anatomical considerations
- •Conservative management
- •Resection principles
- •Mobilization of the liver
- •Incision
- •The hepatic pedicle
- •Methods of parenchymal transection
- •Resection options
- •Segmental resections
- •Traditional resections
- •Non-traditional options
- •Synchronous colon and liver resection
- •Laparoscopic liver surgery
- •Follow-up
- •Re-do surgery
- •Liver tumours
- •Malignant tumours
- •Benign conditions
- •Ascites
- •Oesophageal varices
- •Portosystemic shunts
- •Splenic vein thrombosis
- •Budd–Chiari syndrome
- •Liver abscess
- •Simple liver cysts
- •Hydatid disease
- •Cholecystectomy for uncomplicated gallstones
- •Combined laparoscopic cholecystectomy and ERCP
- •Mirizzi’s syndrome
- •Acalculous disease of the gallbladder
- •Gallbladder tumours
- •Gallbladder polyps
- •Benign conditions
- •Sclerosing cholangitis
- •Primary duct stones
- •Polyps
- •Caroli’s disease
- •Postsurgical intrahepatic stones
- •Idiopathic
- •Biliary dyskinesia
- •Long-term management of benign strictures
- •Trauma
- •Iatrogenic
- •Endoscopic trauma
- •Penetrating or blunt injury
- •Cholangitis
- •Following ERCP
- •Bile duct stones
- •Postsurgical cholangitis
- •Bile duct tumours
- •Bibliography
- •Index

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abdominal sepsis, postoperative,
cholecystectomy, known bile duct
stones 241
acalculous disease of gallbladder 242–3
access limbs, in cholangitis 271–3, 272
accessory duct (of Santorini) 38
adenocarcinoma, pancreatic 56–87, 57 , 59–61
ampullary tumours 97–102, 98 ,
99–101 , 260
biliary bypass procedure
(hepaticojejunostomy) 65–72, 66–71
determining operability 62–5, 62–4
pancreaticoduodenectomy 72–86,
73–82 , 86
alcohol-related pancreatitis 5–6
recurrent 6
amoebiasis, differential diagnosis 198
amoxycillin/clavulinic acid 264
ampullary stenosis 225, 260, 262
ampullary tumours 97–102, 98 , 99–101 , 260
amylase, drain fluid assay 34
antibiotic resistance 264
APUD cells 51
argon beam coagulation 154
ascites 167–75
acute pancreatitis 15
peritoneo-venous shunting 169, 169–75
balloon dilatation, endoscopic trauma to
biliary tract 266–8
balloon exploration of CBD 2 28
balloon tamponade, oesophageal
varices 181–5, 181–3 , 185
baskets
exploration of CBD 2 28
impacted 268–70, 270
bile duct, see also biliary tract
bile duct cysts, choledochal cysts 257–8, 257
bile duct dilatation 260–3
ampullary stenosis 260, 262
biliary dyskinesia 263
Caroli’s disease 258–9
idiopathic 260
investigation 264
pancreatitis 260–3, 262
bile duct injury 264–70
endoscopic trauma to biliary tract 266–70
management 267
bile duct investigation
laparoscopic 225–9
open 229–35
bile duct polyps 257
bile duct stones 271
known bile duct stones 223–35, 226
laparoscopic exploration 225–9, 227–8
open exploration 229–35, 229–33
pancreatitis, acute 4–5
possible bile duct stones 222–3, 223
postsurgical intrahepatic stones 259
primary duct stones 255
see also gallstones
bile duct tumours 273–82
biliary anatomy, common variations at
hilum 117
biliary bypass (hepaticojejunostomy),
pancreatic adenocarcinoma 65–72
biliary dyskinesia 263
biliary excretion, delayed 271
biliary tract 253–82
benign conditions 253–9
benign strictures, long-term
management 263–4
cholangiocarcinoma 273–82, 274
cholangitis 270–3
choledochal cysts 257–8, 257
inflammatory strictures 255–7, 256
polyps 257
trauma 264–70
avoidance of injury 264–70
endoscopic trauma 266–70
iatrogenic 266–70
see also bile duct; gallbladder
biliary tract trauma 266–70
bilioenteric anastomoses 281
postsurgical cholangitis 271
bilirubin levels, pancreatic surgery 58
bleeding, oesophageal varices 175, 176–7
Budd — Chiari syndrome 193–4
C-reactive protein [CRP] 4, 26
CA 19-9 estimations 43, 44, 58, 65, 142, 148,
195, 273
sclerosing cholangitis 255
Calot’s triangle 213
carcinoembryonic antigen (CEA)
estimations 44, 58, 141–3, 148,
152, 273
carcinoid syndrome 157
Index
Note: page numbers of figures and tables are denoted by italics

INDEX
310
carcinoid tumours of liver 157–60, 158–9
management 158
miliary disease 157, 159
carcinoid tumours of pancreas 51
Caroli’s disease 258–9
cholangiocarcinoma 273–82
management 274–5 , 275
resection 273–82, 276–9
surgical bypass 280–2
segment III bypass 280, 280–1
segment V bypass 280–2, 282
surgical treatment 58, 274 , 275–82
cholangiography 219–20
selective 222
T-tube 233–5
cholangitis 270–3
ascending 195
following ERCP 270–1
postsurgical stricture 271–3
access limbs 271–3, 272
bilioenteric anastomoses 271
sclerosing 253–5
cholecystectomy 211–42
cholecystectomy, known bile duct
stones 223–42
age, and management strategy 224
bile leaks from drains 238–40
combined laparoscopic cholecystectomy
and ERCP 225, 235–6
conversion to open operation 215, 217–18
delayed postoperative problems 240–1
abdominal sepsis 241
jaundice 240
management 239
hilar dissection 118
immediate problems 238–40, 239
late presentations 241–2
strictures 224, 241–2
management 226
open exploration 229–35
pain 238, 242
postcholecystectomy syndrome 242
cholecystectomy, possible bile duct
stones 222–3, 223
cholecystectomy for uncomplicated
gallstones 211–22
cholangiography 219–22
laparoscopic cholecystectomy 211–17,
213–14 , 216–17
open cholecystectomy 217–22, 218 , 220–2
cholecystitis
acalculous 242–3
xanthogranulomatous 219
choledochal cysts 257–8
types 257
choledochocele 257
choledochoscopy 232–3
choledochotomy 227–35
T-tube placement 231–2
ciprofloxacin 264
circular stapler, lower oesophagus 186
cirrhosis, surgery 184
colorectal carcinoma liver metastases 152–7
liver resection 140, 164
management 153 , 156
PET scanning 155–7
common bile duct (CBD) see bile duct;
biliary tract
compartment syndrome
acute pancreatitis 15–16
pancreatitis, acute 15–16
cystadenocarcinomas 144–8,
147
cystic pancreatic tumours 41–5, 41–5
cysts see choledochal cysts; pancreatic cysts;
polycystic liver disease; pseudocysts
Denver shunt 169
devascularization procedures, liver
185–7, 186
Sugiura procedure 187
diffuse endocrine system (DES) 51
drain fluid assay, amylase 34
duodenal adenocarcinoma 102
duodenal bleeding 94–6
benign bleeding 94, 95
malignant bleeding 95–6, 95
duodenal diverticula 104
duodenal trauma 89–94
first and second part 89–92, 90–1
delayed presentation 92, 94
management 90
third and fourth part 92–4, 92–3
duodenal tumours 97–104
benign tumours 97
malignant tumours 97–102, 98
adenocarcinoma 102, 103–4
ampullary tumours 97–102, 98 , 99–101
invasion from external malignancy 102
management 96
duodenal ulcer, perforation 96, 96
duodenum 89–104
Kocherization 63 , 65, 83
Echinococcus 200–4
E. multilocularis 200
E. oligarthus 200
encephalopathy 187
endocrine tumours of pancreas 51–6, 53–6
endoscopic retrograde
cholangiopancreatography (ERCP) 3–4,
34–6, 59, 90, 210, 223–9, 235–9, 242, 246,
253–61
cholangitis following ERCP 270–1
failed 270
indications and complications 269
sphincterotomy 266

INDEX
311
endoscopic trauma to biliary tract 266–70
balloon dilatation 266–8
endoscopic sphincterotomy 266, 268
impacted baskets 268–70, 270
penetrating or blunt injury 270
endoscopic ultrasound (EUS) 4
enteroenterostomy 69–70
enterotomy 69–70
ethanolamine oleate, sclerotherapy 178
fistulae, pancreatic 34–6
fungal superinfections, liver abscess 195, 197
gallbladder 209–52
acalculous disease 242–3
see also biliary tract
gallbladder cancer 244–51
investigation/management 245–6
surgical options 247–8
surgical procedure 248–51, 249–51
gallbladder polyps 243–4
gallbladder surgery
iatrogenic trauma 264–70
impacted baskets 268–70, 270
late indicators of bile duct injury 265–6
liver trauma 106–11, 107
gallbladder tumours 243–51
polyps 243–4
gallstones 209–43, 210
and abnormal liver function tests 223
acute pancreatitis 4–5
incidence 209
management 210
spilled 242
see also bile duct stones; cholecystectomy
gastric balloon 182
gastric varices 179–81, 179–80
gastroenteropancreatic axis (GEP) 51
gastroenteropancreatic-neuroendocrine
tumours (GEP-NETs) 51–6, 53–6
presentation, sites, and malignant
potential 56
gastroenterostomy, pancreatic tumours 65–72
gastrointestinal stromal cell (GIST) metastases
of liver 160–4, 163
management 163
gastrosplenic ligament 46
GEP–NETs 51–6
Glissonian sheath 123
glucose tolerance test, islet cell
transplantation 25–8, 27
haemorrhage, retroperitoneal bleeding 17–18
hepatectomy see liver resections
hepatic, see also liver
hepatic cystadenomas and
cystadenocarcinomas 144–8, 147
hepatic duct, abnormal right hepatic duct 216
hepatic ducts, Roux loop 279
hepatic pedicle 116–25
hilar dissection 116–22, 116–22
intrahepatic approach 123–5, 123–5
segmental pedicles, identification 125
hepatic vein, right and left anomalies 106
hepaticojejunostomy
adenocarcinoma 65–72, 66–71
pancreatic adenocarcinoma 65–72
hepatobiliary imino-diacetic acid scan
(HIDA) 271
hepatocellular carcinoma 148–52, 149–50
ablation 151
investigation/treatment 149–50
surgery 151–2
hepatoduodenal ligament
cancer 248–51
Pringle manoeuvre 110 , 114
hilum
common variations in biliary anatomy 117
hilar dissection 116–22, 116–22
cholecystectomy 118
structure 120
hydatid disease 200–4
diagnosis 201
differential diagnosis 198
treatment 201–4, 202
imatinib mesylate (Glivec ® ) 160
impacted baskets 268–70, 270
inflammatory masses
hepatic mass investigation 142–3, 143
pancreas
acute pancreatitis 7
investigation/treatment 59 , 60
inflammatory strictures, biliary tract 255–7,
256
insulin, post islet cell transplantation 28
islet cell infusion 27
islet cell transplantation 25–8, 27
jaundice, postoperative, following
cholecystectomy 240
jejunostomy, feeding 91, 104
Klatskin tumour 275
Kocherization of duodenum 63 , 65, 83
lanreotide 157
laparoscopic bile duct investigation 225–9
laparoscopic cholecystectomy
and ERCP 225, 235–6
gallstones in CBD 225–9
uncomplicated gallstones 211–17, 213–14 ,
216–17
laparoscopic liver surgery 140–1
laparoscopic pancreatic surgery 86–7
laparostoma, pancreatitis 16, 16

INDEX
312
liver 105–207
see also hepatic
liver ablation 137–8
liver abscess 194–7
differential diagnosis 195
organisms 195
recurrent or refractory abscesses 197
treatment 195–7, 196
liver anatomy 105–6, 105–6
Couinaud’s nomenclature 105
liver biopsy 144
liver cysts 197–200
differential diagnosis 195, 196
treatment 198–200, 199–200
liver devascularization procedures 185–7, 186
liver function tests 263
abnormal 254
liver resections 111–42
central venous pressure 115
cytoreduction 160
follow-up 141
hepatic pedicle 116–25
hilar dissection 116–22, 116–22
incision 113–16, 113–15
intrahepatic approach 123–5, 123–5
intraoperative ultrasound 116
laparoscopic liver surgery 140–1
left hepatectomy 122 , 132, 132
extended 132–3, 133–4
liver mobilization 113
non-traditional options 133–40
ablation 137–8
local excision 139–40, 139
portal vein embolization 135–7, 137–8
staged procedures 134–5, 135–7
parenchymal transection 125
principles 111–25
Pringle manoeuvre 110 , 114
re-do surgery 141–2
right hepatectomy 114–16, 122 , 130–1,
131 , 250
extended 133, 134
segmental resections 126–30
segment I (caudate lobe) 126
segment II 126–7
segment III 126–7, 127
segment IV 127–9, 128–9
segment V 129–30
segment VI and VII 130
segment VIII 105–6 , 130
synchronous colon and liver resection 140
traditional resections 130–3
liver trauma 106–11
assessment 107
conservative management 106–11, 108–10
management 109
liver tumours 142–64
benign tumours 144–8, 145–6
CT, MRI, and red cell scan appearances 147
hepatic cystadenomas and
cystadenocarcinomas 144–8, 147
management 146 , 148
extrahepatic disease 112
hepatic mass investigation 142–3, 143
lung metastases 112
malignant/metastatic tumours 148–64
carcinoid tumours 157–60, 158–9
colorectal carcinoma 152–7, 153 , 156
gastrointestinal stromal cell (GIST)
tumours 160–4, 163
neuroendocrine metastases 160, 161–2
non-colorectal, non-neuroendocrine
metastases 164, 165
primary hepatocellular carcinoma
148–52, 149–50
miliary disease 159
lymphadenectomy 248–51
magnetic resonance
cholangiopancreatography (MRCP) 4,
24, 35, 210 , 220, 223–4 , 236, 239 , 242,
256 , 261 , 267 , 274
Mirizzi’s syndrome 212, 236–7, 237
neuroendocrine metastases of liver 160
incidentally discovered 161
management 162
neuroendocrine tumours of pancreas 51–6,
53–6
GEP-NETs 51–6
WHO classifications 51, 53
octreotide 10, 34, 157
oesophageal varices 175–85
acute bleeding 175, 176–7
balloon tamponade 181–5, 181–3 , 185
gastric varices 179–81, 179–80
management 176
sclerotherapy 175–9, 178
splenic vein thrombosis 192–3, 193
oesophagus, circular stapler 186
pancreas 1–87
anatomy 37–9
congenital abnormalities 38
developmental anatomy 37–8, 38
early history 1
lymphatic drainage 39
surgical anatomy 38–9
pancreas divisum 38
pancreatectomy
distal 43–5
distal pancreatectomy for malignant
disease 49–51
and islet cell transplantation 25–8, 27
reconstruction after 27
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