Introduction Total pancreatectomy is associated with significant metabolic consequences secondary to the loss of exocrine and endocrine function. Resultant brittle type III diabetes can be difficult to manage and result in severe recurrent hypoglycemia in some patients. Outcomes after total…
Open central (segmental) pancreatectomy is also described in detail and remains an alternative for benign, indolent, or premalignant lesions in the pancreatic neck, when an enucleation is not feasible and a lymphadenectomy not required. This technique preserves normal pancreatic tissue…
Operative approach Pancreaticoduodenectomy (PD) is one of the few remaining operations where major morbidity rates hover in the range of 25% and the 90-day mortality rate remains in the 2% to 4% range, even under the care of the highest-volume…
Introduction Hemobilia and bilhemia are clinical phenomena that arise from admixing of blood and bile due to anomalous connection between the bloodstream and biliary tract. In general terms, a fistula between the hepatic arterial supply and the bile ducts can…
Introduction A wide variety of lesions may affect the liver and pancreatic vasculature. These lesions range from common to exceedingly rare, and they can be acquired or congenital. Some are harmless, whereas others have a high risk of causing morbidity…
Introduction Injuries to the pancreas and the duodenum are some of the most feared injuries in trauma. Because of the location of the pancreatoduodenal complex (PDC) and the surrounding structures, even simple injuries are complicated and have the potential of…
Introduction The majority of hepatobiliary injuries are managed nonoperatively, supported by tenets of patient selection, appropriately timed adjunct interventions, and careful monitoring. The liver is a well-vascularized solid organ (see Chapter 5 ), making hemorrhage a common cause of mortality…
Type 1 diabetes mellitus (DM), formerly known as “juvenile diabetes,” is characterized by hyperglycemia resulting from the nearly complete destruction of insulin-producing β-cells of the pancreatic islets of Langerhans. The loss of β-cells is the result of a T lymphocyte–mediated…
Liver transplantation (LT) has evolved from a high-risk procedure with significant morbidity and mortality to a standard treatment for patients with liver failure. Patients who undergo successful liver replacement have 1-year and 5-year survival rates that exceed 85% and 70%,…
Historic overview Thomas Starzl attempted the first human liver transplantation (LT) in 1963 in a 3-year-old child with biliary atresia (BA; see Chapter 125 ). Unfortunately, the child died in the operating room from uncontrollable hemorrhage. Just a few years…