Skip to Main Content

Introduction

Surgical therapy for hepatopancreaticobiliary disease has a rich history with meteoric advances occurring over the last century. Perhaps surprisingly, it was not until 1848, and the description of pancreatic lipase by French physiologist Claude Bernard, that the exocrine function of the pancreas was recognized.1 In 1899, William Stewart Halsted first successfully resected the head of the pancreas along with the duodenum for ampullary cancer. This evolved into the one-stage pancreaticoduodenectomy described by Allen Oldfather Whipple in 1940.2 Puestow and Gillesby introduced the lateral pancreaticojejunostomy for the management of chronic pancreatitis in 1958, and Frey and Child introduced the 95% distal pancreatectomy in 1965. Carl Langenbuch performed the first successful cholecystectomy in 1882, and the first elective hepatic resection for tumor in 1888.3 The modern era of hepatic resection was brought about in 1952 when Lortat-Jacob and Robert performed the first true anatomic liver resection with primary vascular control.4

Advances in technology over the next few decades were crucial in the evolution of hepatopancreaticobiliary surgery. The first laparoscopic cholecystectomy was performed by Mouret in 1987 and more widely described by Dubois in 1988.5 Andrew Warshaw described the utility of laparoscopy in the diagnosis and staging of pancreatic cancer. The first endoscopic papillotomy for calculi removal was performed by Safrany in 1980, and this evolved into endoscopic retrograde cholangiopancreatography (ERCP), a crucial adjunct for management of biliary disease.6 The development of new surgical instruments such as the harmonic scalpel and LigaSure vessel-sealing system made liver resections more expeditious and decreased transfusion requirements.

With improved surgical technique, the indications for pancreaticobiliary surgery have also expanded. Surgical resection of pancreatic cancer can now include portomesenteric venous resection if arterial inflow can be preserved.7 Techniques for resection have also been refined and optimized. Pylorus-preserving pancreatoduodenectomy, for example, is equally effective from an oncologic perspective when compared to the standard Whipple procedure, with similar recovery and complication profiles.8 The DISPACT trial examined stapled and hand-sewn closure for distal pancreatectomy and showed no difference in subsequent pancreatic fistula formation.9 This chapter will also discuss nonoperative advancements in the field, including the utility of prophylactic octreotide to reduce pancreatic fistulas,10,11 and new chemotherapeutic regimens for metastatic pancreatic cancer.12 In addition to cancer, this chapter will also discuss the management of benign pancreatic disease, including pancreatic cysts13 and severe pancreatitis.14,15,16

Despite advancements in management, pancreatic cancer remains a leading cause in cancer-related death, and pancreatic resection is still associated with significant complications.1 The development of risk assessment tools and consensus statements has helped guide decision making and improve outcomes.17 International study groups have also reached consensus on the definition of several of the more common postoperative complications. This consensus is essential for future research, as it enables accurate comparisons between trials. Pancreatic fistula is now defined as a drain output of ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.