CONTENTS
CONTENTS
Hepatic
SECTION EDITOR: Quyen D. Chu
Preoperative Dilemmas
1 What Imaging Modality Do I Need to Get to Assess Liver
Lesions and How Do I Interpret Them? 1
Guillermo P. Sangster, Maren Donato,
and Horacio R.V. D’Agostino
2 How Do I Prepare A Patient For Hepatic/Biliary Surgery,
How Much Future Liver Remnant (FLR) Is Needed In A
Healthy Versus Cirrhotic Liver, and What Steps Should I
Take If the FLR Is Inadequate? 12
Cataldo Doria and Allison David
3 What Is the Ideal Margin Width After Hepatectomy for
Colorectal Metastases and Hepatocellular Carcinoma? 17
Ibrahim Nassour and Michael A. Choti
4 How Should I Manage Disappearing Colorectal Liver
Metastases? 20
Eliza W. Beal and Timothy M. Pawlik
5 Should I Treat Viral Hepatitis Before Resecting HCC? 26
Junichi Shindoh
6 How Should I Manage A Patient with Recurrent
Colorectal Liver Metastases and One with Synchronous
Colorectal Liver and Lung Metastases? 31
Anya Adair and Stephen J. Wigmore
7 Is There a Role for Liver Resection in Patients with Non-
Colorectal, Non-Neuroendocrine Metastases? 37
Anthony M. Villano and Lynt B. Johnson
8 What is the Utility of Liver Scoring Systems in the
Management of Hepatocellular Carcinoma (HCC)? 44
Ronald Matteotti, Steven J. Nurkin, and John F. Gibbs
9 Liver Hemangioma, Focal Nodular Hyperplasia, and
Hepatic Adenoma: How Do I Tell Them Apart and When
Should They Be Resected? 53
Aras Emdadi, Gazi B. Zibari, and Quyen D. Chu
10 NASH, CASH, and Steatohepatitis: What Are the
Concerns and How to Diagnosis Them? 67
Hrishikesh Samant and Wuttiporn Manatsathit
11 How Should the HPB Surgeon Manage the Patient with
Polycystic Liver Disease? 73
Zaheer S. Kanji and Adnan A. Alseidi
12 How Do I Diagnose and Manage Amoebic and Pyogenic
Liver Abscess? 81
Avinash N. Supe and Vinaykumar B. Thapar
13 Should Hepatectomy be Performed in Octogenarians? 90
Catherine H. Davis, Bradford J. Kim, and Thomas A. Aloia
14 How to Prepare for Major Liver Resection/
Pancreatectomy in a Jehovah’s Witness Patient? 96
Edward E. Cho, Houssam Osman,
and D. Rohan Jeyarajah
15 Should We Resect Primary Colon Adenocarcinoma for
Patients with Unresectable Liver Metastases? 104
Jeffrey Reha and Pannandai S. Somasundar
16 Is There a Role for Living Donor Liver Transplantation for
Hepatocellular Carcinoma? 109
Khalid Khwaja and Robert A. Fisher
17 How Should I Handle Hepatocellular Carcinoma?
Resection or Transplantation? 114
Alagappan Annamalai and Andrew Klein
XXXIV CONTENTS

Pro/Con Debates
24 What Are the Different Techniques in Liver Parenchymal
18 A Patient with Colorectal Cancer and Synchronous Liver Dissection and Transection? 210
Metastases: Vincent E. de Meijer and Bas Groot Koerkamp
A) Simultaneous Resection of Primary and
Metastases: 121 25 What Are the Different Vascular Control Techniques for
Roberto Hernandez-Alejandro Liver Resection and On Whom Should I Use Them? 214
and Kerollos Nashat Wanis François Cauchy and Jacques Belghiti
B) Liver Resection First (Reverse Strategy): 128
Marc-Antoine Allard and René Adam Postoperative Dilemmas
C) Resect the Primary First: 133
Somala Mohammed, Steven A. Curley, 26 What Are the Post-Hepatectomy Complications and How
and Avo Artinyan Should I Manage Them? 227
Miguel-Angel Mercado
19 Neoadjuvant Chemotherapy for Colorectal Liver and Hiram Raul Muñoz Gonzalez
Metastasis:
A) Pro: 137

Biliary
Eddie K. Abdalla
B) Con: 143
Michael E. Lidsky and Michael D’Angelica SECTION EDITOR: Gazi B. Zibari

20 Should Patients Undergo Associating Liver Partition and Preoperative Dilemmas

Portal Vein Occlusion for Staged Hepatectomy (ALPPS)
or Two-Stage Hepatectomy (TSH) 27 How to Avoid Injuring the Biliary Tree During
A) ALPPS: 149 Laparoscopic Cholecystectomy and How to Manage it
Fernando A. Alvarez When it Does Happen? 232
and Eduardo de Santibañes Dominic Sanford and Steven M. Strasberg
B) Two-Stage Liver Resection: 158
Takashi Mizuno, Rebecca A. Snyder, 28 How Should I Manage Retained Common Bile Duct
and Jean-Nicolas Vauthey Stone(s) in Patients With and Without A Previous Gastric
Bypass? 247
21 A Patient with Liver Metastases from Neuroendocrine Gazi B. Zibari and Quyen D. Chu
Tumor
A) Resection: 166 29 How Should I Manage Intrahepatic Biliary Stones? 261
Amar Gupta and Elijah Dixon Henry A. Pitt, Janak Parikh
B) Transplantation: 170
Wellington Andraus, Daniel Reis Waisberg, 30 How Should I Approach a Cirrhotic Patient with Acute
and Luiz Augusto Carneiro D’Albuquerque Cholecystitis? 268
Jad Abou-Khalil and Scott Helton
22 What Approach is Best for Hepatic Hydatid Cyst?
A) Percutaneous: 179 31 How to Manage a Gangrenous Gallbladder. What To Do
Okan Akhan, Turkmen Ciftci, When the Biliary Anatomy Is Unclear? 274
and Devrim Akinci Felipe José Fernández Coimbra
B) Surgical: 188 and Maria Luiza Leite de Medeiros
Fernando Duek and Javier C. Lendoire
32 How Should I Manage Gallstone-Related
Intraoperative Dilemmas Acute Cholangitis? 278
Ronald S. Mowad and Quyen D. Chu
23 How to Manage Tumors Involving the Retrohepatic
Inferior Vena Cava 201
33 How Do I Diagnose and Manage Patients with Acute
Alan W. Hemming, and Jennifer Berumen
Acalculous Cholecystitis (AAC)? 283
Ajay Jain, Natesh Yepuri, and Dilip S. Kittur

34 How to Diagnose and Manage Biliary Dyskinesia? 288
James McClintic and Kimberly Brown
35 How to Manage Cystic Duct Remnant and
Post-Cholecystectomy Syndrome? 292
Lucio Lucas Pereira and Horacio J. Asbun
36 How Should I Manage a Patient with a
Choledochal Cyst? 297
Danielle M. Fritze and Francisco G. Cigarroa
37 Should a Cholecystectomy Be Done For
Gallstone Ileus? 305
Marcelo Fasano and Alberto R. Ferreres
38 How to Diagnose and Manage Caroli’s Disease and
Mirizzi’s Syndrome? 311
Nathan Zilbert, Eisar Al-Sukhni, Shiva Jayaraman,
and Sean Cleary
39 What Should I Do with An Incidentally Detected
Gallbladder Polyp? 318
Mohammad Y. Zaidi, Aarti Sekhar, and Shishir K. Maithel
40 Do All Porcelain Gallbladders Need Surgery and, If So,
Do I Need to Perform a Radical Cholecystectomy
at the Onset? 327
Rachel E. Beard and David A. Geller
41 How to Differentiate Biliary Cystadenomas from
Cystadenocarcinomas and How Should They be
Managed? 331
Doug P. Slakey and David T. Pointer, Jr.
42 Who to Resect for Gallbladder Cancer and How Extensive
Should the Resection Be? 337
Julie N. Leal and Brendan C. Visser
43 How Do I Diagnose and Treat Intrahepatic
Cholangiocarcinoma? 344
Zeljka Jutric and Yuman Fong
44 Is Staging Laparoscopy Necessary for Potentially
Resectable Perihilar Cholangiocarcinoma? 352
Robert J.S. Coelen and Thomas M. van Gulik
45 Should the Caudate Lobe Be Routinely Resected for Hilar
Cholangiocarcinoma? 358
Masato Nagino
CONTENTS XXXV
46 Should a Feeding Tube Routinely Be Placed For Patients
Undergoing Hepato-Pancreato-Biliary Operations? 366
Austin Dosch and Aram N. Demirjian
47 Is Biliary Drainage of the Future Liver Remnant
Important After Liver Resection for Perihilar
Cholangiocarcinoma? 370
Laura M. Enomoto and Niraj J. Gusani
48 A) Portal Vein Is Involved In a Patient with Hilar
Cholangiocarcinoma: Proceed with Surgery and
Resect Portal Vein: 375
Palepu Jagannath and Gunjan Desai
B) What Is The Best Approach For Hilar
Cholangiocarcinoma With Portal
Vein Involvement? 386
Michelle Babicky and William R. Jarnagin
Postoperative Dilemmas
49 How Should I Manage Postoperative Bile Leak? 393
Blayne A. Sayed and David A. Kooby
Pancreas
SECTION EDITOR: Charles M. Vollmer, Jr.
Preoperative Dilemmas
50 A Patient Needs a Pancreatectomy But Has A Cardiac
History Demanding Anticoagulation Therapy. How Do
You Manage This? 399
Zachary Brown and Jonathan Hernandez
51 Is There a Role for the Surgeon in the Management of
Locally-Advanced Pancreatic Cancer? 405
Michael D. Kluger and John A. Chabot
52 A Patient Has a Resectable Pancreatic Head Cancer But is
83 Years Old. Should I Perform a Whipple? 412
Sandeep Jhajj and Taylor S. Riall
53 The Patient Presents with a Pancreatic Head Mass with
Jaundice and a Bilirubin of 20. Should You Operate Soon
or Stent the Bile Duct? 419
Tyler S. Wahl and John D. Christein
XXXVI CONTENTS
54 A Resectable Pancreatic Head Tumor Invades
the Transverse Mesentery and Would Require A
Hemicolectomy. Is It Worth the Added Risk? 421
Joal D. Beane and Eugene P. Ceppa
55 A 25-Year-Old Female Presents with a Story of “Chronic
Pancreatitis”. The Pancreas is Radiographically Normal.
Should You Perform a Total Pancreatectomy with Islet
Autoransplantation? 425
Katherine Morgan
56 A 55-Year-Old Patient Has Chronic Pancreatitis With a
Head-Dominant Disease. What Operation is Best – Beger,
Frey, Whipple, or Puestow? 430
Brent T. Xia, Vikrom K. Dhar, and Syed Ahmad
57 A Patient Has a 2.0 cm Side-Branch IPMN and is 45 Years
of Age. Should I Operate or Follow? 440
Georgios Gemenetzis and Christopher L. Wolfgang
58 What Are Grove Pancreatitis and Pancreatic Divisum and
How Do I Deal With Them? 446
David B. Adams and Andrew Hardie
Pro/Con Debates
59 A 1.5 cm Neuroendocrine Tumor is Identified in the
Pancreatic Head. Should I Operate or Not?
A) The Case for Resection: 452
Catherine H. Frenkel and John D. Allendorf
B) The Case for Observation: 456
Alessandra Pulvirenti and Peter J. Allen
60 A Patient Presents with a Pancreatic Adenocarcinoma
Which Is In Apposition with the Porto-splenic
Confluence. Should I Operate Now or Later?
A) The Case for Up-Front Surgery: 460
Melanie K. Sion and Charles J. Yeo
B) The Case for Preoperative Therapy: 468
Jordan M. Cloyd and Matthew H.G. Katz
Intraoperative Dilemmas
61 A Pancreatic Cancer at the Portal Confluence Requires
a Vein Resection. How Do You Reconstruct the Vein –
Primary Repair, Venous Conduit, Synthetic Graft? 474
Jordan M. Cloyd and Jeffrey E. Lee
62 How to Manage the High-Risk Pancreatic
Anastomosis? 481
Brett L. Ecker and Charles M. Vollmer, Jr.
63 Should I Place an Intraoperative Drain for Distal
Pancreatectomy? 490
Zachary E. Stiles and Stephen W. Behrman
64 Should You Get Frozen Sections During a Whipple for
Pancreatic Cancer or IPMN? 495
Jashodeep Datta and Jeffrey A. Drebin
65 Should the Spleen Be Preserved in a Distal
Pancreatectomy? 501
William P. Lancaster and Attila Nakeeb
66 A Single Metastatic Focus is Identified in the Liver During
a Planned Resection for Pancreatic Malignancy? Should I
Proceed? 506
Alessandro Paniccia and Richard D. Schulick
67 You Find Locally Unresectable Disease During an
Exploration for a Periampullary Cancer. How Do You
Best Palliate? 510
Motaz Qadan and Keith D. Lillemoe
68 On Whom Should You Perform Local Excision Versus
Pancreatoduodenectomy for An Ampullary Mass? 517
Andre Luis Montagnini and Thiago Nogueira Costa
Pro/Con Debate
69 Should I Place an Intraoperative Drain for Whipple’s
Resection?
A) The Case for Drainage: 523
George van Buren 2nd and William Fisher
B) The Case Against Drain Use: 526
John W. Kunstman and Ronald R. Salem
Postoperative Dilemmas
70 A Septic Patient with a Completely Dehisced Pancreatico-
jejunostomy (ISGPF Grade C) Requires a Reoperation on
POD#7. How Do You Manage This? 533
Rachel E. Beard and Mark P. Callery
71 How Should I Approach Post-Pancreatectomy
Hemorrhage? 537
Major K. Lee, IV
72 A Patient Presents with An Intraluminal Hemorrhage
After Whipple. What Do I Do Now? 544
Nisa Kubiliun and Rebecca M. Minter

73 A Patient Has a Chyle Leak Following a Pancreatic
Resection. How Do You Manage This? 549
Carlos Chan and Gabriela Del Angel
74 There Is Bile In the Intraoperatively Placed Drain Early
After A Whipple Resection. What Should You Do? 552
Jason B. Liu and Marshall S. Baker
75 When Should a Patient Who Requires a Splenectomy for a
Distal Pancreatectomy Be Vaccinated? 557
Na Eun Kim and Teviah E. Sachs
76 A Patient Undergoes a Pancreatectomy for Pancreatic
Cancer. Should They Receive Extended Anticoagulation
Therapy Beyond Discharge? 561
Elizabeth A. Bailey and Robert E. Roses
77 A Stable Patient POD#7 From a Whipple is Ready for
Discharge But Has a High Likelihood for Readmission.
What Should You Do? 565
Zhi Ven Fong and Carlos Fernández-del Castillo
78 How Do I Manage a Patient Who Has “Failure to Thrive”
Following a Pancreatic Resection? 569
Rachel E. Beard and Tara S. Kent
Pro/Con Debate
79 Should I Use a Somatostatin Analogue After a Whipple
Resection?
A) Pro: 573
Shailesh V. Shrikhande and Esha Pai
B) Con: 578
Divya Sood and Andrew Lowy
Transplantation
SECTION EDITOR: Susan L. Orloff
LIVER TRANSPLANTATION
Preoperative Dilemmas
80 How Should I Optimize a Patient With Acute
Cholecystitis and End-Stage Liver Disease? 582
Jared A. White and Devin Eckhoff
81 Management of Hepatorenal Syndrome– When to Start
Hemodialysis and When is a Patient a Candidate for
Simultaneous Liver Kidney Transplant? 589
Eric Langewisch and Scott Westphal
CONTENTS XXXVII
82 How Should One Optimally Treat a Patient with
Hepatocellular Cancer Who is Waiting for a Liver
Transplant? 596
Angela S. Volk and Joseph F. Buell
83 How Should Simultaneous Liver Kidney (SLK) Waitlisted
Patient be Managed? What Is The Optimal Timing of
Transplanting the Kidney? 601
Dave L. Scott
84 What Are the Protocols for Downstaging Hepatocellular
Carcinoma (HCC) to Within Milan Criteria,
Transplantation Outside of Milan Criteria? – Pros and
Cons of Center Specific Approaches 604
Adeel S. Khan, Kathryn J. Fowler,
and William C. Chapman
85 Management of Hepatic Hydrothorax on the Waitlist
– Pleural Tube or Not? TIPS or Not? Indications and
Strategies 611
Michael D. Voigt and Arvind Murali
86 How Should I Manage Patients with Hepatopulmonary
Syndrome and Portopulmonary Hypertension Who Are
On The Waitlist? 617
Amy Gallo, Roham T. Zamanian, and Waldo Concepcion
87 How Should I Manage Spontaneous Bacterial Peritonitis
While the Patient Is On The Waitlist? When to Activate
for Liver Transplantation? 627
Helen S. Te
88 How Should I Manage a Leaking Umbilical Hernia in
High MELD Wait Listed Patients? 632
Devin E. Eckhoff and Jared A. White
89 Obesity In The Liver Transplant Candidate – What Is The
Ideal Strategy? 637
Julie K. Heimbach
90 How Much Steatosis To Tolerate In The
Donor Allograft? 644
Arun P. Palanisamy, Vinayak S. Rohan,
and Kenneth D. Chavin
91 To Anticoagulate or Not in the Setting of a Waitlisted
Patient with Portal Vein Thrombosis and Varices.
What Agent to Use? 649
Michael Loudin and Joseph Ahn
XXXVIII CONTENTS
92 Viral Hepatitis: How Should I Manage HBV in the
Waitlisted Patient? 655
James Fung and Marina Berenguer
93 The Management of Hepatitis C Before and After Liver
Transplantation: When and When Not to Treat, and How
to Treat When Treatment is Indicated? 659
Richard Gilroy
94 How Should One Evaluate and Manage a Liver Transplant
Candidate Who Also Has A Substance Use Disorder? 669
Thomas Soeprono, Sara Houck, and Stacey McCandlish
95 When Is A Patient Too Sick to Transplant? Keeping the
High MELD Patient Alive While Awaiting for
Transplant? 677
Yumi Ando and Willscott Naugler
96 How Can Donor-Recipient Matching Optimize Donation
After Circulatory Death (DCD) Liver Utilization? 683
C. Kristian Enestvedt
97 What Are The Indications for Living Donor Liver
Transplant (LDLT)? 688
Kendra D. Conzen and Elizabeth A. Pomfret
98 How Do You Decide Whether to Use the Right Lobe or
Left Lobe in a Live Donor Liver? 695
Dong-Hwan Jung and Sung-Gyu Lee
99 What Are The Indications for Split Liver Transplantation,
When to Use Both Livers; Right Lobe/Left Lobe, Left
Lateral Section/Right Trisegment, etc? 702
Esteban Halac and Javier Lendoire
100 How Should We Match Donor Organ Quality with
Recipient Severity of Illness? 716
Kenneth Washburn and Sylvester M. Black
101 Machine Perfusion Techniques to Enhance Quality of
Marginal Liver Organs and to Prolong Ischemia Times
Without Deleterious Effects – Which Approach is Best:
Normothermic vs Hypothermic? 720
David Nasralla and Peter J. Friend
102 Pediatric Liver Transplantation – What Are The
Indications, Timing, Technical Aspects, and
Complications? 726
Oscar Imventarza and Guillermo Cervio
103 Should Transplantation Be Considered for Patients with
Unresectable Cholangiocarcinoma? 743
Charles B. Rosen
104 Is There a Role for Liver Transplantation for Metastatic
Neuroendocrine Tumors? 752
John F. Renz, Geraldine C. Diaz,
and Christoph E. Broelsch
Intraoperative Dilemmas
105 Management of Hepatorenal Syndrome, Renal
Insufficiency Intraoperatively-Intraoperative CRRT? 757
Dragos M. Galusca and Marwan S. Abouljoud
106 How Should I Address Anastomotic Size Mismatches
Between Donor and Recipient: (A) Bile Ducts, (B) Portal
Veins, (C) Hepatic Arteries, (D) Hepatic Vein/Caval
Anastomoses? 762
Hillary J. Braun and John P. Roberts
107 What Are The Technical Aspects of Dealing with
Anastomotic Mismatches in Liver Transplantation? 768
Martin I. Montenovo and Jorge D. Reyes
108 Options For Aortohepatic Conduits in Liver
Transplantation: When to Use What? 775
Peter T.W. Kim and Goran B. Klintmalm
109 Biliary Reconstruction for Liver Transplantation in
Patients with Primary Sclerosing Cholangitis: Which
Approach is Best - Choledochocholedocostomy or Roux-
en-Y Hepaticojejunostomy? 783
Kyle R. Jackson and Andrew Cameron
110 What Are The Technical Strategies in Retransplantation?
How to Explant the Liver? Anastomotic Variants and
Approaches? 788
Flavio Paterno, T. Mark Earl, and Shimul A. Shah
111 When to Use Venoveno Bypass? (Rarely Needed- But
There Are Some Indications) 793
W. Shannon Orr and Christopher D. Anderson
112 How to Use Thromboelastography to Guide Blood
Product Usage in Liver Transplantation? 801
Mark S. Orloff, Stewart Jay Lustik, and Majed A. Refaai
113 What Are the Intraoperative Coagulation Issues During
Liver Transplantation: An Anesthesiologist’s
Perspective 809
Emily Baird and Elizabeth Duggan

114 What Are the Issues in Intraoperative Management
of Patients Undergoing Liver Transplantation: An
Anesthesiologist’s Perspective 815
Emily Baird and Elizabeth Duggan
115 How Should I Manage Intraoperative Pleural Effusions
During Liver Transplantation: Transdiaphragmatic vs
Chest Tube Drainage? 822
T. Mark Earl and Siddharth Desai
116 Is tPA Protocol with Infusion into the Recipient Hepatic
Artery in Donation After Circulatory Death (DCD) Livers
to Prevent Ischemic Cholangiopathy Useful? 825
Nicolas Goldaracena and Paul D. Greig
Postoperative Dilemmas
117 How Should I Manage Hepatic Artery Thrombosis After
Liver Transplantation? 828
Mary Decoteau, Jamie Case, and Christopher Lee Marsh
118 How to Manage Portal Vein Thrombosis in Liver
Transplantation? 835
George E. Loss, Jr. and David S. Bruce
119 How Should I Manage Early Venous Outflow Obstruction
in Liver Transplantation? 842
C. Kristian Enestvedt and Erin Maynard
120 How Should I Manage Biliary Strictures and Leaks After
Liver Transplantation? 847
Juan F. Guerra and Alberto Espino
121 What Are The Indications and Timing for Liver
Retransplantation? 851
Erin C. Maynard
122 What Should I Look for in a Liver Transplant Recipient
Who Has a Fever? 856
Sui Kwong Li and Lynne Strasfeld
123 What Are the Common Perioperative Cardiac Events
During and After Liver Transplantation? 862
Elliot I. Grodstein and David P. Foley
124 When Should You Repair an Umbilical or an Inguinal
Hernia in a Cirrhotic or a Post-Liver Transplant
Patient? 870
Vijay Subramanian and Majella Doyle
CONTENTS XXXIX
125 What Are the Updates on Immunosuppression in Liver
Transplantation? 876
Joshua J. Wiegel
126 What Are the Complications and Management of
Immunosuppressive Therapy in Liver
Transplant Recipients? 886
Domenica McKenna, and Ali J. Olyaei
127 What Are the Indications for Early Reoperation Following
Liver Transplantation? 895
Ashley Suah, Adam S. Bodzin, and J. Michael Millis
PANCREAS TRANSPLANTATION
128 Is There a Role for Islet Cell Transplantation in Patients
with Type I Insulin-Dependent Diabetes Mellitus? Should
Islet Cell Transplant Be Considered for Type II Diabetes
Mellitus Patients? 905
Steven A. Wisel and Peter G. Stock
129 When Should Pre-emptive Solitary Pancreas Transplant
Be Considered for a Patient with Type I Diabetes
Mellitus? 911
Adarsh Vijay, Matthew Cooper, and Peter Abrams
130 What is the Utility of Simultaneous Pancreas Kidney
Transplantation in Patients with Advanced Diabetic and
Kidney Disease? 916
Dixon B. Kaufman
131 Who Should Get a Pancreas Transplant, Which Technique
and How to Manage Its Rare Complications? 922
Hosein Shokouh-Amiri and Gazi B. Zibari
132 How Should One Manage Pancreatic/Duodenal Leak after
Transplantation: Observation, Stenting, Percutaneous
Drainage or Surgical Correction? 929
Leigh Anne Dageforde and Jason Wellen
133 A Patient is Two Years Post Pancreas Transplant with
Bleeding from the Donor Arterial Conduit Aneurysm.
What is the Role of Surgery and Interventional
Radiology?” 937
Armando Ganoza and Abhinav Humar
134 A Pancreas Transplant Recipient Has Acute Allograft
Dysfunction: What is the Differential Diagnosis and How
Should It Be Managed? 942
Neeraj Singh, Aleksandra Kukla, and Jon S. Odorico
XL CONTENTS
Trauma
SECTION EDITOR: Mallory Williams
HEPATIC TRAUMA
135 Is There a Role for Non-Operative Management of
Patients with Right Upper Quadrant
Penetrating Trauma? 949
Adil Shah and Edward E. Cornwell, III
136 Is There a Role for Operative Management of Blunt
Hepatic Trauma in the “Nonoperative
Management Era”? 952
Matthew Benns and J. David Richardson
137 How Do We Best Manage Traumatic Retrohepatic Inferior
Vena Cava Injury? 960
Alfred E. Baylor, III and Robert F. Wilson
138 A Patient with Non-Expanding Hematoma from Vena
Caval Injury Due to Penetrating Injury. Is There a Role
for Percutaneous Stenting? 966
Sean Rogers and Farzad Alemi
139 What is the Role of Vascular Shunting for Major
HPB Trauma? 970
Chad G. Ball and Amar Gupta
140 What is the Role of Hepatic Transplantation for
Hepatobiliary Trauma? 975
Rupak D. Kulkarni and Jeffrey H. Fair
141 How Should We Manage Gallbladder Injury Concomitant
with Hepatic Trauma? 985
Jon D. Dorfman and Heena P. Santry
142 What Are the Different Hemostatic Techniques in Hepatic
Trauma? 988
Lenworth Jacobs
143 How Do We Manage Hepatobiliary Injuries & Their
Complications? 995
LD Britt
PANCREATICODUODENAL TRAUMA
144 How Do We Manage Trauma to the Distal Pancreas: Is
Splenectomy Always Required? 1006
Wayne A. I. Frederick
145 Operative Management of Penetrating Trauma to the
Pancreatic Head and Duodenum: Is There Still a Role for
Pancreaticoduodenectomy? 1014
Charles E. Lucas, and Anna M. Ledgerwood
146 How Do We Manage the Challenging Duodenal Injury
Between the Ampulla and the Vessels? 1025
Anna M. Ledgerwood, Miguel Tobon,
and Charles E. Lucas
147 How Should We Manage Penetrating Pancreatic and SMA
Trauma? 1038
Rebecca Plevin and Andre Campbell
148 What is the Role of Non-operative Management in
Pancreatic Trauma? 1048
Navdeep S. Samra, Piyush Kalakoti,
and Mallory Williams
149 Is There a Role for Endoscopic Retrograde
Cholangiopancreatography (ERCP) in
Pancreatic Trauma? 1055
Choichi Sugawa and Charles E. Lucas
150 How Do We Diagnose and Manage the Complications of
Pancreatic Trauma? 1064
Robyn Richmond, Mallory Williams,
and Brian H. Williams
INJURY TO THE PORTA HEPATIS
151 How Do We Manage Penetrating Trauma to the
Extrahepatic Biliary Tree? 1068
Kimberly Joseph and Lee Cartagena
152 Operative Management of Portal Vein/Superior
Mesenteric Vein Trauma:
Can We Just Ligate? 1073
Tze-Woei Tan and Alik Farber
153 Hepatic Artery Trauma: Repair or Ligate? 1079
Ronald Tesoriero and Thomas Scalea
154 How Do We Diagnose and Manage Complications of
Biliary Trauma? 1085
Lisa M. Knowlton and David A. Spain
SPECIAL TOPICS
155 How Do We Manage Hepatobiliary and Pancreatic
Trauma in the Damage Control Era? 1093
Mallory Williams

156 How Do We Manage HPB Injuries in the Perioperative
Period? 1098
Sharven Taghavi, Reza Askari, Mallory Williams,
and Selwyn O. Rogers, Jr
157 Improving Quality Through Integration of the
Hepatobiliary and Transplant Surgeons Into The Trauma
Team: How To Achieve The Goal? 1104
Mallory Williams and Wesley Francis
158 What Are The Special Considerations in the Management
of Pediatric HPB Trauma? 1109
Jamie Golden, Wesley Barry, Henri Ford,
and Jeffrey S. Upperman
159 What is the Role for Extracorporeal Membrane
Oxygenation (ECMO) in Improving Survival After
Hepatic Trauma? 1116
Mallory Williams, Jenna Aziz, and Salim Aziz
Innovation
SECTION EDITOR: Mariano E. Giménez
Preoperative Dilemmas
160 Will Technology, Along with Proper Training and
Teaching, Improve Patient Outcome? 1123
Jorge Cardoso Cuneo and Andrés Garelli
161 What is the Future of Surgery?  1127
Mariano E. Giménez
162 How Many Classifications Are There for Acute
Pancreatitis & Which One Should We Be Using? 1134
Michael G. Sarr
163 Is Antibiotic Therapy Currently the First Step in the
Treatment of Infected Acute Necrotic Collections of the
Pancreas?  1140
Savio G. Barreto and John A. Windsor
164 A Patient With Severe Acute Pancreatitis and Necrosis
Shows Systemic Inflammatory Response Syndrome (SIRS)
9 Days After the Onset of Pancreatitis - What Should We
Do? 1144
Sven M. van Dijk, Rogier P. Voermans,
and Marc G.H. Besselink
CONTENTS XLI
165 When is Open Debridement Indicated for Necrotizing
Pancreatitis? 1151
Nicholas J. Zyromski
166 There is a Well-Formed Large Pseudocyst With a
Thickened Wall. What Should be Done? 1156
Gustavo Andreoli, Roberto Valinas, and Mario Almada
167 A Patient with Hemorrhagic Pancreatitis Who Has Failed
Embolization. What is the Next Step? 1164
Gustavo Kohan and Ornella Agnes Ditulio
168 Should Percutaneous and Endoscopic Therapies be
Performed by HPB Surgeons? 1170
Mariano Palermo and Mariano E. Giménez
169 A Patient Requires a Whipple Resection-Should I Do This
Using a Traditional Open Approach
or Robotically? 1177
Mashaal Dhir and Amer H. Zureikat
Pro/Con Debates
170 Preoperative HPB biopsy:
A) Rarely Needed: 1183
Perparim Limani, Claire Goumard,
and Claudius Conrad
b) Always: 1187
Claudemiro Quireze, Jr
171 Preoperative Percutaneous or Endoscopic Biliary
Drainage for Klatskin and Pancreatic Cancer?
A) Yes: 1193
Vagner B. Jeismann and Paulo Herman
B) No: 1197
Sergio Pacheco and Nicolas Jarufe
Intraoperative/Technical Dilemmas
172 Image Fusion, Virtual Reality and Hybrid Imaging in HPB
Surgery - Landmark Innovations or New-Fangled
Technology? 1202
Michele Diana and Jacques Marescaux
173 Single-Port Hepato-Pancreato-Biliary Surgery: Myth or
Reality? 1211
Xabier de Aretxabala and Marcelo Vivanco
174 Do Duodenal Stents Replace Palliative Surgery In
Advanced Pancreatic Cancer? 1214
Jiaywei Tsauo and Ho-Young Song
XLII CONTENTS

175 Which Type of Local Ablation Should We Use for Treating

Liver Cancer: Ethanol, RFA, Microwave Ablation,
Cryoablation or Irreversible Electroporation? 1219
Mariano E. Giménez and Manuel E. Zeledón

Pro/Con Debates

176 Palliative Treatment of Malignant Jaundice - Percutaneous

vs. Endoscopic & Echoendoscopic Approaches?
A) Percutaneous: 1224
Eduardo Houghton
B) Endoscopic: 1230
Thomas M. Runge and Todd H. Baron

177 Should Patients Undergo Radiofrequency Ablation (RFA)

or Surgical Resection for Small Hepatocellular Carcinoma
(HCC)?  
A) RFA: 1240
Marcos R. Meneze, Guilherme L. Martins,
and Maurício R. Liberato de Moura
B) Resection: 1248
Oscar C. Andriani

178 Ablative Therapy: Percutaneous or Laparoscopic?

A) Case for Percutaneous: 1257
Pablo Acquafresca
B) Case for Laparoscopic: 1263
Amit Sastry and David Iannitti

Postoperative Dilemmas

179 Bioethics - Implications of Use of Technology - Where

Are We Going? 1268
Bruce Schirmer

180 Follow-up images - When and What? The Case of

Gallbladder Polyps 1275
Mariano Volpacchio and Christine Menias

181 Laparoscopic, Endoscopic, or Percutaneous Techniques

for Postoperative Complications from HPB Surgery: Pros
and Cons 1279
Edgardo Serra and Caetano Finger