Overview Minimally invasive techniques to manage biliary pathology have reduced the need for open operative intervention. Although open exploration for biliary disease has become less common, specific situations like obstructive common duct stones not amenable to endoscopic therapy or restoration…
Radiologic hepatobiliary interventions Minimally invasive hepatic intervention is indicated in a wide range of pathologic conditions and can be generally divided into vascular, biliary, and hepatic parenchymal procedures. The objective of this chapter is to provide a broad overview of…
Equipment needed for standard endoscopic retrograde cholangiopancreatography cannulation Before attempting cannulation of the biliary tree for standard endoscopic retrograde cholangiopancreatography (ERCP), the appropriate equipment must be assembled (see Chapter 20 ). At baseline that equipment should include : Side-viewing duodenoscope…
The concepts of health and quality of life Promotion of health and restoration of quality of life is central to the delivery of healthcare. There is limited value in engaging in a medical intervention if there is no anticipated impact…
Imaging and image-guided therapy of complications after pancreatectomy Imaging after pancreatectomy Computed tomography (CT) is the most common imaging modality for evaluation of the pancreas after surgery. Complications that can be detected on CT include anastomotic leak, abscess, fistula, and…
Introduction In the 1990s, initial reports of fast-track surgical principles detailed their application to cardiac surgery patients with the goal of reducing intensive care unit (ICU) stay. Afterward, a novel multimodal approach to perioperative care was described by Kehlet and…
Assessment of patient nutritional status and functional reserve allows surgeons to identify malnourishment and potential recovery before major abdominal surgery. Evolving nutritional and fluid management strategies, along with improving anesthesia, pain management, and hemodynamic monitoring, seek to minimize homeostatic alterations.…
Overview Improvements in patient selection criteria, advances in hepatopancreatobiliary (HPB) surgical techniques, and perioperative care have enabled increasing numbers of older and previously deemed inoperable patients to undergo HPB surgery. Despite this increase in comorbidities, recent studies have documented the…
Overview The management of hepatobiliary and pancreatic disease has evolved greatly since the 1990s. Today’s operative surgeon has several valuable adjuncts to aid in accurate preoperative evaluation and planning for benign and malignant disease. Advances in contrast-enhanced computed tomography (CT),…
Introduction Percutaneous image-guided needle biopsy (PNB) is the cornerstone for diagnosis and treatment of many diseases involving the liver. Minimally invasive, PNB is an effective outpatient procedure with a low complication rate. The success of PNB requires proper patient selection,…