The Roux-en-Y Hepatica-jejunotomy (RYHJ) is considered the gold standard of care in iatrogenic complex bile duct injury. The RYHJ will lead to stricture in 4 to 10% of cases. Redo surgery, endoscopy and percutaneous cholangiography are the three available therapeutic options. Nowadays, the majority of these strictures are managed by biliary drainage and balloon dilatation as a first approach. The duration of biliary drainage as well as the baboon calibration is still controversial. In this article we discuss the use of cutting balloon in 8 cases as a first approach to manage benign biliary stenosis after R YHJ.

This book covers interventional treatments (minimally invasive therapies) for the management of various hepato-biliary disorders and the complications arising due to liver cirrhosis and portal hypertension. Given that interventional radiology and hepato-biliary interventions are comparatively new, very little literature is available on them. This book addresses that gap and offers practitioners and trainees a guide to the management of various hepato-biliary disorders requiring radiological interventions. The content addresses both non-vascular and vascular procedures. The respective chapters cover various procedures, such as image guided diagnostic tissue sampling (FNA and biopsies), guided liver abscess and biliary drainage procedures, liver tumor ablation, intra-arterial and intravenous techniques for the management of vascular diseases of the liver and portal hypertension, variceal bleeds and tumor management. Last but not the least, detailed chapters on interventions for post liver transplant complications are also included. The book is chiefly intended for practicing interventional radiologists, as well as fellows and trainees in interventional radiology courses.

This book provides a comprehensive overview of non-surgical treatments for complicated and refractory biliary and pancreatic lesions. In particular, it offers non-surgical treatment options for benign biliary strictures. For those suffering from intractable total biliary obstruction following biliary operation, magnetic compression anastomosis represents a good therapeutic option, and this technique is fully explained. Moreover, the book describes diverse treatment modalities for hilar stricture, which is one of the most challenging areas of ERCP. Several chapters cover a variety of important aspects of this area. The book also aims to identify and solve the unmet needs for the diagnosis and treatment of biliary and pancreatic diseases. The precise explanations of treatment concepts and strategies will both increase readers’ knowledge and provide assistance in daily clinical practice. The authors are pioneering experts from around the world, and the text is supported by numerous informative illustrations and helpful summaries.

Balancing basic science with information on everyday clinical practice, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 7th Edition, provides you with expert guidance and advances in the field so you can offer patients the most optimal diagnostic and surgical care. In two convenient volumes, Dr. William Jarnagin and his team of internationally recognized surgeons cover exactly what you need to know, including advances in diagnostic and surgical techniques, minimally invasive surgeries, new interventional diagnostic techniques, and all relevant diseases. This comprehensive, practical reference is designed to help you choose and perform the most appropriate procedures that will minimize inpatient hospital time, curtail costs, and reduce overall recovery time for your patients. Presents cutting-edge guidance on pathology, diagnostics, surgery and non-operative intervention of the liver, biliary tract, and pancreas in one highly regarded, authoritative reference. Covers all surgical approaches, both open and minimally invasive. Considers all worldwide opinions and approaches to management, and includes key data on surgical outcomes to better inform clinical decision-making. Contains 161 chapters with updated references and additional figures—more than 1,500 illustrations in all. The imaging section has been reorganized to reflect a disease-based approach. Includes new and expanded sections on advances in molecular characterization of benign and malignant HPB diseases, perioperative management, interventional techniques, minimally invasive surgery and robotics, and therapeutic advances for malignant disease. Features a section dedicated entirely to operative technique, plus a new historical chapter authored by Professor Jacques Belghitti: “Hepatobiliary and Pancreatic Surgery: Historical Perspective.

Over the last two decades, there have been major advances in imaging, endoscopy, and laparoscopy in the field of gastrointestinal (GI) surgery. GI surgery is the newest sub-specialty branch of general surgery, where enhanced expertise and high-volume centres have made a difference to the outcomes of complex operations. Surgeons can now do difficult procedures with low morbidity and mortality rates, and greatly improved overall results. This volume provides detailed and up-to-date knowledge on diseases of the liver, gall bladder, and bile ducts. Split into two sections, it covers anatomy and physiology, approaches to specific conditions and traumas, a thorough analysis of current knowledge and future advances in the field, and a review of the relevant literature. Written and edited by world-renowned experts in the field, this book will be a valuable resource for hepatobiliary surgeons and trainees, general surgeons, researchers, and medical students.

This book provides detailed insight to the readers into various aspects of bile duct injury. Bile duct injury is a common complication of cholecystectomy to treat gall stone disease prevalent all over the world. Risk of bile duct injury is more during a laparoscopic procedure as compared to open procedure and most cholecystectomies today are performed laparoscopically. Bile duct injury causes major morbidity and may even result in death, additionally it increases the healthcare costs and impairs quality of life. It is therefore important that every surgeon who performs cholecystectomy knows how to suspect, diagnose, manage and prevent bile duct injury. This book provides practical information and offers assistance in managing patients with difficult cases of bile duct injury. It summarises Dr Kapoor’s experience with management of more than 1,000 patients with post-cholecystectomy bile duct injury/ biliary stricture. Chapters cover anatomy, epidemiology, mechanism, pathophysiology, clinical presentation, investigations, classification, diagnosis, management and prevention of bile duct injury. It also includes non-medical issues including health care, socio-economic, costs and quality of life.

This unique textbook provides a concise and practical approach to clinical dilemmas involving the liver, pancreas, and biliary tree. Six major sections encompass (1) Hepatic, (2) Biliary, (3) Pancreas, (4) Transplantation, (5) Trauma, and (6) Innovative Technology. Each topic is written by recognized experts from an "e;experiential"e; viewpoint combined with evidence-based medicine. The book contains over 170 chapters and over 350 contributors. It is relevant to Surgical Oncologists, Hepato-Pancreato-Biliary (HPB) Surgeons, Transplant Surgeons, Traumatologists, HPB Interventionalists, General Surgeons, and trainees and students. The title of each chapter is in a form of a clinical scenario and each chapter begins with a Case Scenario and ends with Salient Points. Special debates are included in each section. There are numerous compelling images, detailed illustrations, comprehensive tables, thorough algorithms, and other adjunctive tools that enhance learning. The authors emanate from different corners of the world. The book is a valuable resource for faculty, students, surgical trainees, fellows, and all health care providers in the HPB/Trauma/Transplant/Oncology fields.

Although benign biliary disease is an area in which many surgeons have experience, there are many nuances to providing the highest quality of surgical care. The biliary anatomy is unique but presents with anatomical variances and can be distorted by benign pathology. Biliary surgery has been one of the areas where minimally invasive techniques were first applied in the late 1980s. However, surgical technique has continued to evolve due to acquisition of advanced minimal surgical skills and improvement in surgical technology. The expertise, sage, and knowledge of the members of the Society of American Gastrointestinal and Endoscopic Surgery (SAGES) have prioritized the creation of this manual on modern biliary surgery. This manual will provide the standard for the current state of biliary surgery in the 21st century. The SAGES Manual of Biliary Surgery will align with the new SAGES University Masters program. The Manual supplements the Masters Program Biliary Surgery Pathway. Its goal is to help the surgeon progress from the competent to the proficient and finally to the mastery level. Both for the surgical trainee and senior surgeon, this guidebook will also give insight into modern evaluation and management. The highlights will emphasize what is both feasible and safe from a minimally invasive approach in biliary surgery. The concept of Safe Cholecystectomy will be defined and expounded on in detail. The difficult cholecystectomy will be given ample coverage to include management of intraoperative bile duct injury, indications and techniques of subtotal cholecystectomy, and special attention to intraoperative diagnostic imaging that serve as adjuncts, including cholangiograpy, ultrasound, as well as indocyanine green biliary fluorescence. We will review the updated international Tokyo guidelines for acute cholecystitis. Furthermore, the evolution of treatment of choledocohlithiasis has evolved the most in recent years, and thus requires an extensive discussion of the non-operative and operative management of bile duct stones. This text will serve as an important contribution to the medical literature sponsored by SAGES, an international leading authority in gastrointestinal surgery with a keen interest in safe and proficient biliary surgery. Leaders in the field of biliary surgery will impart their insight and considerable experience in the chapters planned for this manual. The intent for this manual is to be the cited resource for high quality and applicable knowledge for the treatment of benign biliary disease.

This text provides a comprehensive review of ERCP and EUS and the clinical conditions for which they are employed. Presented in a case-based format with accompanying videos, it will serve as a valuable practical clinical resource for gastroenterologists with an interest in ERCP and EUS. The text highlights major techniques involved in ERCP, reviews complications and recent data on preventing post-ERCP pancreatitis, and discusses important issues in training in ERCP including use of endoscopic simulators and assessment of competency as emphasized in the new ACGME guidelines. For biliary diseases, new techniques for managing biliary stones, novel technologies for diagnosing indeterminate biliary strictures, and new devices for treating benign and malignant strictures are also highlighted. For pancreatic diseases, advances in minimally invasive endoscopic techniques for pancreatic stones and strictures, and management of the complications of pancreatitis are reviewed. Furthermore, ERCP is not limited by age, pregnancy or history of abdominal surgeries and special considerations particular to these patient populations are also discussed. The EUS chapters review the breadth of equipment available for performing EUS and EUS-FNA, detail the technique of performing EUS-FNA, and explore pertinent issues with training and assessing competency analogous to ERCP training. Valuable insights on the basics of cytopathology relevant to the endosonographer are summarized. The classic indication for EUS of staging luminal cancers is examined in detail while pancreaticobiliary indications are discussed highlighting newer adjunctive technologies including elastography and contrast-enhanced EUS. Although in its infancy, the brave new world of therapeutic EUS is explored with a focus on endoscopic necrosectomy, EUS-guided biliary and pancreatic access as well as the exciting possibilities of EUS-guided radiofrequency ablation and injection of anti-tumor agents. ERCP and EUS: A Case Based Approach will serve as a very useful resource for physicians who perform or refer patients for ERCP and EUS. It provides a concise yet comprehensive summary of the current status of ERCP and EUS that will help guide patient management and stimulate clinical research. ​