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Hepato-Pancreato-Biliary surgery

Martin de Santibañes, Eduardo de Santibañes, Juan Pekolj
The paradigm introduced by William Halsted for surgical residency training has been considered the most appropriate educational system to acquire the knowledge and surgical skills required to become a competent general surgeon. Hepato-pancreato-biliary (HPB) surgery is considered an important part of general surgery training because of its high prevalence and complexity. Nowadays, we are faced with a worldwide shortage of general surgeons candidates, restrictive working hours and less surgical exposure, situations that can undermine the objectives of training in HPB surgery during residency...
October 21, 2016: Journal of Hepato-biliary-pancreatic Sciences
Perparim Limani, Michael Linecker, Philipp Kron, Panagiotis Samaras, Bernhard Pestalozzi, Roger Stupp, Alexander Jetter, Philipp Dutkowski, Beat Müllhaupt, Andrea Schlegel, Claude Nicolau, Jean-Marie Lehn, Henrik Petrowsky, Bostjan Humar, Rolf Graf, Pierre-Alain Clavien
BACKGROUND: Solid tumors, such as hepato-pancreato-biliary cancer, develop tumor hypoxia with tumor growth. Despite advances in surgery, a majority of these patients are in an unresectable condition. At this stage standard cytotoxic chemotherapy regimens are applied with limited success. Novel biological treatment options based on an antiangiogenic mechanism of action neglect other hypoxia mediated mechanisms (e.g. epithelial-mesenchymal transition, Warburg effect, and immunological response) leading to an increased invasiveness with a poor outcome...
October 19, 2016: BMC Cancer
Kazuhiro Hayashi, Yukihiro Yokoyama, Hiroki Nakajima, Masato Nagino, Takayuki Inoue, Motoki Nagaya, Keiko Hattori, Izumi Kadono, Satoru Ito, Yoshihiro Nishida
BACKGROUND: Operation for hepato-pancreato-biliary cancer is among the most invasive open abdominal operations, with a high postoperative morbidity and mortality rate. The purpose of the present study is to investigate whether a preoperative 6-minute walk distance can predict major postoperative complications after operation for hepato-pancreato-biliary diseases. METHODS: A total of 81 participants who underwent pancreaticoduodenectomy, major hepatectomy with extrahepatic bile duct resection, or hepatopancreatoduodenectomy were included...
September 26, 2016: Surgery
Hong-Chuan Zhao, Ruo-Lin Wu, Fu-Bao Liu, Yi-Jun Zhao, Guo-Bin Wang, Zhi-Gong Zhang, Fan Huang, Kun Xie, Xiao-Ping Geng
AIM: The treatment of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. The aim of this study was to report short and long term outcomes and analyze the factors associated with long term survival for patients who underwent hepatic resection for large HCC. METHODS: All patients who underwent hepatic resection for large HCC at the department of Hepato-Pancreato-Biliary Surgery of the First Affiliated Hospital of Anhui Medical University between August 2005 and December 2011 were identified and included for analysis...
September 14, 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Binhao Zhang, Wei Dong, Hongping Luo, Xuanru Zhu, Lin Chen, Changhai Li, Peng Zhu, Wei Zhang, Shuai Xiang, Wanguang Zhang, Zhiyong Huang, Xiao-Ping Chen
Hepato-pancreato-biliary (HPB) tumors are common in China. However, these tumors are often diagnosed at intermediate/ advanced stages because of the lack of a systemic surveillance program in China. This situation creates many technical challenges for surgeons and increases the incidence of postoperative complications. Therefore, Dr. Xiao-Ping Chen has made many important technical improvements, such as Chen's hepatic portal occlusion method, the anterior approach for liver resection of large HCC tumors, the modified technique of Belghiti's liver-hanging maneuver, inserting biliary-enteric anastomosis technique, and invaginated pancreaticojujunostomy with transpancreatic U-sutures...
October 2016: Science China. Life Sciences
Marcel J van der Poel, Marc G Besselink, Federica Cipriani, Thomas Armstrong, Arjun S Takhar, Susan van Dieren, John N Primrose, Neil W Pearce, Mohammad Abu Hilal
Importance: Widespread implementation of laparoscopic hemihepatectomy is currently limited by its technical difficulty, paucity of training opportunities, and perceived long and harmful learning curve. Studies confirming the possibility of a short and safe learning curve for laparoscopic hemihepatectomy could potentially benefit the further implementation of the technique. Objective: To evaluate the extent and safety of the learning curve for laparoscopic hemihepatectomy...
July 6, 2016: JAMA Surgery
Uirá Fernandes Teixeira, Marcos Bertozzi Goldoni, Mayara Christ Machry, Pedro Ney Ceccon, Paulo Roberto Ott Fontes, Fábio Luiz Waechter
BACKGROUND: - Laparoscopic cholecystectomy is the treatment of choice for gallstone disease, and has been perfomed as an outpatient surgery in many Institutions over the last few years. OBJECTIVE: - This is a retrospective study of a single center in Brazil, that aims to analyze the outcomes of 200 cases of ambulatory laparoscopic cholecystectomy performed by the same Hepato-Pancreato-Biliary team, evaluating the safety and cost-effectiveness of the method. METHODS: - Two hundred consecutive patients who underwent elective laparoscopic cholecystectomy were retrospectively analyzed; some of them underwent additional procedures, as liver biopsies and abdominal hernias repair...
April 2016: Arquivos de Gastroenterologia
Albert Fung, Paul Kelly, Gordon Tait, Paul D Greig, Ian D McGilvray
The potential for integrating real-time surgical video and state-of-the art animation techniques has not been widely applied to surgical education. This paper describes the use of new technology for creating videos of liver, pancreas and transplant surgery, annotating them with 3D animations, resulting in a freely-accessible online resource: The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery ( ). The atlas complements the teaching provided to trainees in the operating room, and the techniques described in this study can be readily adapted by other surgical training programmes...
January 2016: Journal of Visual Communication in Medicine
Erin H Baker, Jacob E Dowden, Allyson R Cochran, David A Iannitti, Eric T Kimchi, Kevin F Staveley-O'Carroll, D Rohan Jeyarajah
BACKGROUND: Hepato-pancreato-biliary (HPB) fellowships in North America are difficult to secure with an acceptance rate of 1 in 3 applicants. Desirable characteristics in an HPB surgery applicant have not been previously reported. This study examines the perceptions of trainees and HPB program directors with regards to positive attributes in applicants for HPB fellowships. METHODS: Parallel surveys were distributed by email with a web-link to current and recent HPB fellows in North America (from the past 5 years) with questions addressing the following domains: surgical training, research experience, and mentorship...
May 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Arunav Sharma, Shantanu Kumar Sahu, Mayank Nautiyal, Navneet Jain
BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Relaparotomy (UR), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing URs, their outcomes and factors that affect mortality. METHODS: Observational, Prospective Study. The study included all the patients who underwent urgent re-laparotomy following laparotomy (emergency, elective) in Himalayan Hospital from 01...
January 2016: Chirurgia
Thijs de Rooij, Marc G Besselink, Awad Shamali, Giovanni Butturini, Olivier R Busch, Bjørn Edwin, Roberto Troisi, Laureano Fernández-Cruz, Ibrahim Dagher, Claudio Bassi, Mohammad Abu Hilal
BACKGROUND: Minimally invasive (MI) pancreatic surgery appears to be gaining popularity, but its implementation throughout Europe and the opinions regarding its use in pancreatic cancer patients are unknown. METHODS: A 30-question survey was sent between June and December 2014 to pancreatic surgeons of the European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association and 5 European national pancreatic societies. Incomplete responses were excluded...
February 2016: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Jae Uk Chong, Sangguen Nam, Hee Jung Kim, Rami Lee, Yunjung Choi, Jae Gil Lee, Kyung Sik Kim
INTRODUCTION: Perioperative fluid restriction is advocated to reduce complications after major surgeries. Current methods of monitoring body fluids rely on indirect volume markers that may at times be inadequate. In our study, bioimpedance analysis (BIA) was used to explore fluid dynamics, in terms of intercompartmental shift, of perioperative patients undergoing operation for hepato-pancreato-biliary (HPB) diseases. METHODS: A retrospective review was conducted, examining 36 patients surgically treated for HPB diseases between March 2010 and August 2012...
May 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Timothy H Mungroop, Denise P Veelo, Olivier R Busch, Susan van Dieren, Thomas M van Gulik, Tom M Karsten, Steve M de Castro, Marc B Godfried, Bram Thiel, Markus W Hollmann, Philipp Lirk, Marc G Besselink
BACKGROUND: Postoperative pain prevention is essential for the recovery of surgical patients. Continuous (thoracic) epidural analgesia (CEA) is routinely practiced for major abdominal surgery, but evidence is conflicting on its benefits in this setting. Potential disadvantages of epidural analgesia are a) perioperative hypotension, frequently requiring additional intravenous fluid boluses or prolonged use of vasopressors; b) relatively high failure rates, with periods of inadequate analgesia; and c) the risk of rare but serious, at times persistent, neurologic complications (hematoma and abscess)...
2015: Trials
Thomas A Aloia, William H Geerts, Bryan M Clary, Ryan W Day, Alan W Hemming, Luiz Carneiro D'Albuquerque, Charles M Vollmer, Jean-Nicolas Vauthey, Giles J Toogood
BACKGROUND: At a recently concluded Americas Hepato-Pancreato-Biliary Association Annual Meeting, a Clinical Practice Guidelines Conference Series was convened with the topic focusing on Venous Thromboembolism (VTE) Prophylaxis in Liver Surgery. The symposium brought together hepatobiliary surgeons from three continents as well as medical experts in hematology and coagulation. METHODS: The content of the discussion included literature reviews, evaluation of multi-institutional VTE outcome data, and examination of practice patterns at multiple high-volume centers...
January 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Ramanathan M Seshadri, Noaman Ali, Susanne Warner, Allyson Cochran, Dionisios Vrochides, David Iannitti, D Rohan Jeyarajah
BACKGROUND: Hepato-pancreato-biliary (HPB) surgery is a complex subspecialty drawing from varied training pools, and the need for competency is rapidly growing. However, no board certification process or standardized training metrics in HPB surgery exist in the Americas. This study aims to assess the attitudes of current trainees and HPB surgeons regarding the state of training, surgical practice and the HPB surgical job market in the Americas. STUDY DESIGN: A 20-question survey was distributed to members of Americas Hepato-Pancreato-Biliary Association (AHPBA) with a valid e-mail address who attended the 2014 AHPBA...
December 2015: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Susanne G Warner, Adnan A Alseidi, Johnny Hong, Timothy M Pawlik, Rebecca M Minter
BACKGROUND: Hepatopancreatobiliary (HPB) surgery fellowship training has multiple paths. Prospective trainees and employers must understand the differences between training pathways. This study examines self-reported fellowship experiences and current scope of practice across three pathways. METHODS: An online survey was disseminated to 654 surgeons. These included active Americas Hepato-Pancreato-Biliary Association (AHPBA) members and recent graduates of HPB, transplant-HPB and HPB-heavy surgical oncology fellowships...
September 2015: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Fabrizio Di Benedetto, Roberto Ballarin, Giuseppe Tarantino
BACKGROUND: Hepatic caudatectomy has always been considered a challenging procedure, because of the complex anatomy and deep location of this segment. Herein we report the first case of a totally robotic isolated caudate-lobe liver resection ever performed for hydatid disease. METHODS: A 55 year-old man was referred to our institution after diagnosis was made of a 5.6 cm hepatic lesion of the caudate lobe. Radiological suspicion was for hydatid disease. The patient underwent robotic-assisted hepatic caudatectomy...
June 2016: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
Thomas A Aloia, Nicolas Járufe, Milind Javle, Shishir K Maithel, Juan C Roa, Volkan Adsay, Felipe J F Coimbra, William R Jarnagin
An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists was convened on 15 January 2014 to review current evidence on the management of gallbladder carcinoma in order to establish practice guidelines. In summary, within high incidence areas, the assessment of routine gallbladder specimens should include the microscopic evaluation of a minimum of three sections and the cystic duct margin; specimens with dysplasia or proven cancer should be extensively sampled...
August 2015: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Afif N Kulaylat, Jane R Schubart, Eric W Schaefer, Christopher S Hollenbeak, Amanda B Cooper, Niraj J Gusani
BACKGROUND: Surgical costs are influenced by perioperative care, readmissions, and further therapies. We aimed to characterize costs in hepato-pancreato-biliary surgery in the United States. METHODS: The MarketScan database (2008-2010) was used to identify privately insured patients undergoing pancreatectomy (n = 2254) or hepatectomy (n = 1702). Costs associated with the index surgery, readmissions, and total short-term costs were assessed from a third party payer perspective using generalized linear regression models...
December 2015: Journal of Surgical Research
Janet P Edwards, Alexsander Bressan, Navjit Dharampal, Sean C Grondin, Indraneel Datta, Elijah Dixon, Sean P Cleary, Jeffrey S Barkun, Jean M Butte, Chad G Ball
This article characterizes the Canadian hepato-pancreato-biliary (HPB) surgery workforce (demographics, practice patterns, career satisfaction, education and recruitment plans). This information will serve as a baseline for future national comparisons, allow informed workforce planning and facilitate mathematical modelling of the HPB workforce in Canada.
June 2015: Canadian Journal of Surgery. Journal Canadien de Chirurgie
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