Hepato-biliary-pancreatic surgery is known to be a particularly difficult field in gastrointestinal surgery. In order to educate the expert Hepato-biliary-pancreatic surgeons who are able to perform safe and reliable high-level procedures, the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) initiated a board-certification system for expert surgeons in 2008. However, even now, complications such as Pancreatic Fistula and postoperative hemorrhage still occur at a certain rate in high-level hepato-biliary-pancreatic surgery. Cooperation between several medical departments including surgeons, IVR physicians and endoscopists is important to overcome these complications. In this section, we generally explain the procedure of Hepato-biliary-pancreatic surgery, reconstructive procedures, postoperative complications as well as surgical management.
In the last decade, the development of interventional EUS and balloon assisted enteroscopy has brought innovation to the field of therapeutic endoscopy. With these innovations, endoscopic intervention has emerged as a first-line therapy for postoperative pancreatic fluid collection (POPFC) and bilioenteric stricture. In this article, we introduced endoscopic intervention for POPFC and bilioenteric stricture with EUS and/or balloon assisted enteroscopy.
Post-operative complications such as abdominal fluid collection, abscess, bile leakage (BL) and pancreatic fistula (PF) can occur after hepato-biliary pancreatic surgery. Effective drainage is essential for these post-operative complications. Here, we describe non-vascular IR techniques for post-operative complications after hepato-biliary pancreatic surgery, showing our cases.
Even in modern times, surgery in the hepatobiliary and pancreatic region remains complicated. Various postoperative complications are experienced, especially postoperative bleeding, which is a severe and life-threatening complication that can occur within a short time. The superiority of interventional radiology over surgical reoperation has been shown as a treatment for postoperative bleeding after pancreatectomy, and it has become the treatment of first choice. Furthermore, since 2016, stent-graft (GORE VIABAHN®) has been approved in Japan, and it is expected that the treatment results and prognosis will be improved by making it possible to preserve hepatic blood flow. This paper summarizes the findings of postoperative bleeding after pancreatic resection and hepatectomy. As an interventional radiology treatment, this paper introduces the basics of hemostasis and the basic handling of stent-grafts and coil embolization as well as other optional treatments that may be useful when stent-grafts cannot be used.
Chest compression for cardiopulmonary resuscitation is essential; however, it can infrequently cause injury to the internal mammary artery (IMA). IMA injury can lead to life-threatening hemorrhage that requires early diagnosis and treatment. Several studies have shown the usefulness of contrast-enhanced computed tomography (CT) in the diagnosis of an IMA injury. A man in his 60s presented with cardiac arrest. Spontaneous circulation was restored with cardiopulmonary resuscitation. Contrast-enhanced CT revealed a mediastinal hematoma with extravasation. He was diagnosed with right IMA injury secondary to the chest compression. However, angiography revealed bilateral IMA injuries. We performed a transcatheter arterial embolization of the two IMAs. In cases of IMA injury secondary to chest compression, angiographic examinations for bilateral IMA injuries should be performed considering the risk of hemorrhage, even if the contrast-enhanced CT shows only a unilateral IMA injury.