From the Guidelines
Landmark articles in hepatopancreatobiliary (HPB) surgery are primarily guided by the most recent and highest quality studies, with a focus on Bismuth's classification of bile duct injuries, the Brisbane 2000 terminology for liver resections, and Makuuchi's criteria for safe hepatectomy, as well as the ALPPS procedure, Whipple's pancreaticoduodenectomy, and the Tokyo Guidelines for acute cholangitis and cholangitis 1.
Key Landmark Articles
- Bismuth's classification of bile duct injuries
- Brisbane 2000 terminology for liver resections
- Makuuchi's criteria for safe hepatectomy
- ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) procedure
- Whipple's original pancreaticoduodenectomy description
- Tokyo Guidelines for acute cholangitis and cholangitis
Influence on HPB Surgical Practice
These landmark articles have shaped current HPB surgical practice by:
- Establishing standardized terminology
- Defining technical approaches
- Informing evidence-based perioperative management
- Guiding treatment algorithms and surgical decision-making
Recent Guidelines and Recommendations
Recent guidelines, such as the 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy 1, and the ERAS society recommendations for liver surgery 1, provide updated recommendations for HPB surgical practice, including the use of adjuncts for biliary tract visualization, management of bile duct injuries, and perioperative care.
Perioperative Care
The ERAS society recommendations for liver surgery emphasize the importance of perioperative care, including fluid management, monitoring, and audit, to improve postoperative outcomes and reduce complications 1.
Conclusion is not allowed, so the answer will be ended here.
From the Research
Landmark Articles on Hepatopancreatobiliary (HPB) Surgery
- The study by 2 assessed the impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections, and found that the introduction of robotic surgery was associated with improvements in some selected outcomes.
- Another study by 3 presented the initial experience in HPB robotic surgery of a specialized unit of a tertiary hospital, and demonstrated that robotic HBP surgery is safe and feasible.
- The study by 4 evaluated the effectiveness and safety of percutaneous transhepatic approach (PTA) to drainage bile leak after HPB surgery, and found that PTA is a valid and safe approach in bile leak treatment after HPB surgery.
- The implementation of a multidisciplinary HPB surgical program (HPB-SP) was evaluated by 5, and found to be associated with significant increases in regional referrals, median monthly clinic visits, and median number of HPB surgical procedures.
- A review of combined liver and pancreatic resections (CLPR) by 6 found that CLPR can be performed with fairly low morbidity and mortality rates, and that postoperative outcomes were not affected by the extent of liver resection or the type of pancreatic resection.
Key Findings
- Robotic surgery is associated with improvements in some selected outcomes, such as reduced operation time, reduced blood loss, and decreased rate of delayed gastric emptying 2.
- Robotic HBP surgery is safe and feasible, and facilitates parenchymal sparing surgery, access to posterior liver segments, and anastomosis in pancreatic reconstruction compared to laparoscopic surgery 3.
- PTA is a valid and safe approach in bile leak treatment after HPB surgery, with a technical success rate of 100% and a clinical success rate of 78% 4.
- The implementation of a multidisciplinary HPB surgical program (HPB-SP) can improve the quality of cancer care and surgical outcomes, and is associated with lower odds of postoperative adverse events 5.
- CLPR can be performed with fairly low morbidity and mortality rates, and patients receiving chemotherapy should be evaluated carefully before surgery is considered 6.