GI Surgery Annual: Volume 26

Contents
About the Editors
Chapter 1: Total Pancreatectomy and Islet Autotransplantation for Chronic Painful Pancreatitis
1.1 Introduction
1.2 Evaluation and Selection of Patients
1.3 Surgical Procedure
1.4 Islet Isolation and Infusion
1.5 Early Postoperative Care
1.6 Surgical Complications
1.7 Islet Function
1.8 Quality of Life
1.9 Pain Resolution
1.10 Conclusions
References
Chapter 2: Cholangiopancreaticoscopy: A Distinct Diagnostic and Therapeutic Tool in the Current Era
2.1 Background
2.2 Equipment and Techniques
2.3 Video Cholangioscope: Mother–Baby Systems
2.4 Single-Operator Cholangioscopy: Catheter-Based System
2.5 Direct per-Oral Cholangioscopy
2.6 Indications
2.7 Application and Efficacy
2.7.1 Intraductal Lithotripsy
2.7.2 Bile Duct Stones
2.7.3 Indeterminate Biliary Strictures
2.7.4 Primary Sclerosing Cholangitis (PSC)
2.7.5 Pancreatic Neoplasms
2.8 Other Applications
2.9 Complications
2.10 Recent Data on Efficacy and Safety
2.11 Conclusion
References
Chapter 3: Non-cirrhotic Portal Fibrosis
3.1 Introduction
3.2 Definition
3.3 Epidemiology
3.4 Aetiopathogenesis
3.5 Pathology
3.5.1 Ultrastructure
3.6 Haemodynamics
3.7 Clinical Features
3.8 Laboratory Features
3.9 Imaging
3.10 Endoscopy
3.11 Hepatic Venous Pressure Gradient
3.12 Liver Biopsy
3.13 HIV and NCPF
3.14 Differential Diagnosis
3.15 Management
3.15.1 Acute Variceal Bleeding
3.15.2 Prevention of re-Bleeding
3.16 Limitations of Data Available on NCPF
3.17 Summary
References
Chapter 4: Recent Advances in Benign Anorectal Disorders
4.1 Anal Fistula
4.1.1 Etiology
4.1.2 Evaluation: Pathology
4.1.3 Evaluation: Radiology
4.1.4 Classification of Anal Fistula
4.1.5 Management
4.1.5.1 Medical
4.1.5.2 Surgical
4.1.5.3 Choice of Procedures
4.1.6 Cardinal Principles of Fistula Management
4.1.7 Application and Relevance of these Principles in the Management of Complex Anal Fistulas
4.1.8 Special Scenarios: Anal Fistulas
4.1.8.1 Anal Fistula with Tuberculosis
4.1.9 Anal Fistula with Acute Abscess
4.1.10 Anal Fistula with Non-locatable Internal Opening
4.2 Hemorrhoids
4.2.1 Internal Hemorrhoids
4.2.2 External Hemorrhoids
4.2.3 Etiology
4.2.4 Medical Treatment
4.2.4.1 TONE Concept
4.2.5 Office Procedures
4.2.5.1 Rubber Band Ligation
4.2.5.2 Sclerotherapy
4.2.5.3 Infrared Coagulation
4.2.6 Surgical Management
4.2.6.1 Thrombosed External Hemorrhoids
4.2.6.2 Acute Hemorrhoid Crisis
4.2.6.3 Hemorrhoidectomy
4.2.6.4 Stapled Hemorrhoidopexy
4.2.6.5 Doppler-Guided Hemorrhoidal Artery Ligation
4.3 Anal Fissure
4.3.1 Pathophysiology
4.3.2 Diagnosis
4.3.3 Classification and Treatment Algorithm
4.3.4 Medical Treatment
4.3.5 LOABAC (Local and Oral Antibiotic and Avoidance of Constipation) Treatment
4.3.6 Botulinum Toxin (Botox) Injection
4.3.7 Surgical Management
4.3.7.1 Lateral Internal Sphincterotomy (LIS)
4.3.7.2 Local Advancement Flaps
4.3.7.3 Fissurotomy and Fissurectomy
4.3.8 Treatment Algorithm of Anal Fissure
4.4 Pilonidal Sinus Disease
4.4.1 Introduction
4.4.2 Asymptomatic Pit Treatment
4.4.3 Acute Abscess Treatment
4.4.4 Chronic Disease Treatments
4.4.4.1 Phenolization of Pit Tracts
4.4.4.2 Laying Open and Curettage under Local Anesthesia (LOCULA)
4.4.4.3 Pit-Picking Techniques
4.4.4.4 Wide En Bloc Excision with either Primary Midline Closure or Healing with Secondary Intention
4.4.5 Off-Midline Closure Techniques: Rotational Vs Advancement Flaps
4.4.6 Minimally Invasive Surgical Techniques
4.4.7 Importance of Long-Term Follow-Up and Recurrence Rates
4.4.8 Conclusions
References
Chapter 5: Progressive Familial Intrahepatic Cholestasis
5.1 Introduction
5.2 Biliary Transport and Regulation
5.2.1 Mechanism of Pruritus in PFIC
5.3 FIC1 Deficiency (Byler’s Disease, PFIC1)
5.3.1 Genotype-Phenotype Correlation
5.3.2 Clinical Profile
5.3.3 Histology
5.3.4 Benign Recurrent Intrahepatic Cholestasis (BRIC)
5.3.5 Disease Course and Outcome
5.4 BSEP Deficiency (PFIC2)
5.4.1 Genotype-Phenotype Correlation
5.4.2 Genetic Classification of BSEP
5.4.3 Clinical Profile
5.4.4 Histology
5.4.5 Disease Course and Outcome
5.5 MDR3 Deficiency (PFIC3)
5.5.1 Genotype-Phenotype Correlation
5.5.2 Clinical Profile
5.5.3 Histology
5.5.4 Intrahepatic Cholestasis of Pregnancy (ICP)
5.5.5 Low Phospholipid-Associated Cholelithiasis (LCAP)
5.5.6 Disease Course and Outcome
5.6 Natural History and Outcomes of FIC1, BSEP, and MDR3 Deficiencies
5.7 TJP2 Mutations
5.8 NR1H4 (FXR) Mutations
5.9 Myosin-5B (MYO5B) Mutations
5.10 Hepatocellular Carcinoma in PFIC
5.11 Diagnosis and Differentials
5.11.1 Low GGT Versus High GGT Cholestasis
5.12 Management
5.12.1 Control of Pruritus
5.12.1.1 Role of UDCA
5.12.1.2 Other Treatments
5.12.1.3 Surgical Diversion
5.12.2 Nutritional Rehabilitation
5.12.3 Liver Transplantation
5.12.3.1 Post-Transplant Diarrhea and Graft Steatosis in FIC1 Disease
5.12.3.2 Post-Transplant Recurrence of Disease in BSEP Deficiency
5.13 Surveillance
5.14 New Treatment Targets
5.15 Conclusion
References
Chapter 6: Training and Credentialing in Multi-Organ Retrieval: Indian Perspective
6.1 Introduction
6.2 Who Should Be Trained for Multi-Organ Retrieval?
6.3 Training Methodology: How to Train?
6.3.1 Fellowship Programs
6.3.2 Didactic Lectures/E-Learning and Cadaveric Workshops
6.3.3 Our Experience
6.3.4 Collaboration Between Centers
6.3.5 Training in Vascular Surgery
6.3.6 Other Aspects to the Trainee
6.4 Who Should Credential Multi-Organ Retrieval?
6.5 Conclusion
References
Chapter 7: Robotic Surgery in Living Donor Liver Transplantation
7.1 Introduction
7.2 Evolution of MIS and Robotic Surgery in Liver Transplantation
7.3 Overview of Technique
References
Chapter 8: Assessment of Tumour Response to Neoadjuvant Therapy for the Treatment of Oesophageal Cancer
8.1 Introduction
8.2 Current Methods of Assessing Response
8.2.1 Gastroscopy and Endoscopic Ultrasound
8.2.2 Structural Imaging (CT and MRI)
8.2.3 Functional Imaging
8.3 Pathological Assessment of Resected Tumour Post-Neoadjuvant Treatment (yp Staging)
8.4 Novel Methods of Assessment
8.4.1 Molecular-Based Biomarkers
8.4.2 Circulating Tumour Cells
8.4.3 Circulating Tumour DNA (ctDNA)
8.5 Conclusion
References
Chapter 9: Proton Beam Therapy in Gastrointestinal Cancers: A Paradigm Shift in Radiotherapy
9.1 Introduction
9.2 Background
9.2.1 Overview of Role of Radiation in Gastrointestinal Cancers
9.2.2 Physics and Rationale for Proton Therapy in GI Cancers
9.3 Role of Proton Beam Therapy (PBT) in Oesophageal and Stomach Cancers
9.4 Role of PBT in Hepatocellular Cancer
9.5 Role of PBT in Cholangiocarcinoma
9.6 Role of PBT in Pancreatic Cancer
9.7 Role of PBT in Colorectal Tumours
9.8 Role of PBT in Liver Metastases
9.9 Role of PBT in Anal Canal Carcinoma
9.10 Conclusions
References
Chapter 10: Immunosuppression in Liver Transplantation
10.1 Introduction
10.2 Discovering the Immunobiology of Transplantation: A History
10.2.1 Controlling the Immune Response
10.2.2 Tolerance
10.2.3 Early Clinical Immunosuppression
10.3 Current Concepts in Transplant Immunology
10.4 Innate Immune System in Transplantation
10.5 Adaptive Immune System in Transplantation
10.6 Allorecognition
10.6.1 Site of Donor-Recipient Interaction
10.7 T-Cell Activation, Proliferation, and Differentiation (the Two-Signal Model)
10.7.1 Relevance to Therapy
10.8 B-Cell Activation and Proliferation
10.8.1 Relevance to Therapy
10.9 Tolerogenesis
10.9.1 Relevance to Therapy
10.10 Pathology of Rejection Following Liver Transplantation
10.10.1 Chronic Rejection
10.11 A Survey
10.12 Induction Therapy (Routine Cases)
10.13 Maintenance Therapy (Routine Cases)
10.14 Induction Therapy in Special Circumstances
10.15 Maintenance Therapy in Special Circumstances
10.16 Infection Prophylaxis
10.17 Rejection Management
10.18 Management of ACR with Biopsy
10.19 Management of ACR Without Biopsy
10.20 Steroid-Resistant Rejection (ACR)
10.21 Antibody-Mediated Rejection (AMR)
10.22 Chronic Rejection
10.23 Graft vs. Host Disease
10.24 Passenger Lymphocyte Syndrome (Alloimmune Haemolysis) Encountered
10.25 Retransplant for Immunological Reasons
10.26 PTLD Encountered
10.27 Other Cancers Encountered
10.28 Tolerance Encountered (Withdrawal or Significant Minimization of Immunosuppression)
10.29 ABO Incompatible Liver Transplant
10.30 Comments From Experience
Appendix
Questionnaire Circulated to Liver Transplant Centres in India
Practical Immunosuppression in Liver Transplant: Experience of Experts in India
Standard Induction
Standard Maintenance
Rejection Management
ABOi Liver Transplant
General Opinions Based on Experience with Immunosuppression Agents in India
Comments/Important Experience Requiring to Be Shared
References
Chapter 11: Advances in Gastrointestinal Surgery
11.1 Non-Operative Treatment of Adhesive Small Bowel Obstruction: Does It Need a Rethink?
11.2 Definitive Chemoradiotherapy for Oesophageal Carcinoma
11.3 Pain in Chronic Pancreatitis
11.3.1 Neurobiology of Pain in Chronic Pancreatitis
11.3.2 Pain Due to Complications of Disease
11.3.3 Other Causes of Pain in Chronic Pancreatitis
11.4 Management of Cystic Tumours of Pancreas
11.4.1 IPMN
11.4.2 Mucinous Cystic Tumours
11.4.3 Serous Cysts of the Pancreas
11.4.4 Solid Pseudopapillary Epithelial Neoplasm (SPEN)
11.4.5 Cystic PNET
11.4.6 International Guidelines for the Management of Cystic Tumours of the Pancreas
11.5 Targeted Therapy in Gastric Cancer
11.5.1 Targeting Mitogenic Signalling
11.5.2 Targeting Angiogenesis
11.5.3 Targeting Immune Checkpoints
11.6 Management of Acute Necrotizing Pancreatitis
11.7 Reoperative Surgery for Failed Ileoanal Pouch
11.7.1 Type of Re-Do Surgery
11.7.2 Indications for Re-Do Surgery
11.7.3 Evaluation of the Patient
11.7.4 Initial Management
11.7.5 Management of Specific Problem(s)
11.7.6 Approaches for Re-Do Surgery of the Pouch
11.7.7 Complications of Revisional/Reconstructive Pouch Surgery
11.7.8 Postoperative Complications
11.7.9 Quality of Life after Re-Do Pouch Surgery
11.8 Predicting Postoperative Mortality in Cirrhotic Patients
11.8.1 Surgical Risk Assessment
11.8.2 Child-Turcotte-Pugh (CTP) Score
11.8.3 ASA Classification
11.8.4 Model for End-Stage Liver Disease (MELD) Score
11.8.5 Mayo Risk Score
11.8.6 MELD Na Score
11.9 Colorectal Surgery: With or Without Bowel Preparation?
11.10 Stepwise Assessment of Patients with Haematochezia
11.10.1 Step 1
11.10.2 Step 2
11.10.3 Step 3
11.10.4 Step 4
11.10.5 Step 5
11.11 Resection Versus Radiofrequency Ablation for Very Early-Stage Hepatocellular Carcinoma
11.12 An Update on Hepatocellular Adenoma
11.12.1 Risk Factors for Development of HA
11.12.2 Modern Classification of HA
11.12.3 Characteristics of Various HA
11.12.4 Imaging of HA
References