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