Biliary LithiasisBasic Science, Current Diagnosis and Management
GIUSEPPE BORZELLINO • CLAUDIO CORDIANO
Biliary Lithiasis
Basic Science,Current Diagnosis andManagement
GIUSEPPE BORZELLINO
Department of SurgeryUniversity of VeronaUniversity Hospital O.C.M. Borgo TrentoVerona, Italy
CLAUDIO CORDIANO
Department of SurgeryUniversity of VeronaUniversity Hospital O.C.M. Borgo TrentoVerona, Italy
Cover illustration: Salvador Dali, The Enigma of Desire, 1929. Oil on canvas. 110 x 150.7 cm.Bayerische Staatsgemäldesammlungen, Munich, Germany.© Salvador Dali. Fondation Gala-Salvador Dali, SIAE 2008
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PREFACE
The first laparoscopic cholecystectomy, performed by Prof. PhilippeMouret in 1987 and described by himself in the first chapter of this book,was an event that revolutionized surgery in the past few decades.
Although the majority of surgeons today are unfamiliar with the histo-ry of early minimally invasive surgery developments, it is important torealize that the advent of laparoscopy led not only to new surgical tech-niques, but also to a change in the doctrine of medical care, by strength-ening the concept of minimal invasiveness.
This is particularly the case for biliary lithiasis, for which laparoscopyhas provided major benefits in terms of both diagnosis and surgical treat-ment. However, our understanding of the etiology of this disease, as wellas the availability of effective medical therapies, have remained substan-tially unchanged over time.
The application of the innovative approach has not been, in routinepractice, without problems: between 1990 and 2000, the rate of seriouscomplications from laparoscopic cholecystectomy were four times higherthan those observed with open surgery. Even initial attempts at laparo-scopic treatment of biliary common bile duct stones resulted in excessivecomplications and associated medico-legal problems. Nonetheless, today,most indications have been stated, techniques have been standardized,and a new aspect to the treatment of biliary lithiasis has appeared.
Such important changes in the field of biliary lithiasis and the extend-ed survey of the new procedures justified an assessment and a setting ofthe new findings with the aim of establishing a balance among basic med-ical knowledge, technological possibilities and clinical applications. Thisrevision process represents the collective efforts of surgeons as well asradiologists, gastroenterologists and endoscopists, particularly from themain European groups in the field, most of which have contributed to thepresent volume. We thank all of our colleagues who accepted our invita-tion. We also apologize to these authors for the pressure that we some-times exerted on them in order to harmonize the various contributions tothis collective work. Finally, we thank Drs. Barbara Ferrario and Donatel-la Rizza at Springer-Verlag for expert advice and editorial organization,which were fundamental to the successful publication of this volume in aflawless editorial drafting.
Verona, May 2008 Giuseppe BorzellinoClaudio Cordiano
TABLE OF CONTENTS
CONTRIBUTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XI
CHAPTER 1 Reflections on the Birth and on the Concept
of Laparoscopic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1P. MOURET
CHAPTER 2 Epidemiology of Biliary Lithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13S. SAUERLAND
CHAPTER 3 Pathophysiology of Cholesterol Gallstone Disease . . . . . . . . . . . . 19P. PORTINCASA, A. MOSCHETTA, A. DI CIAULA, D. PONTRELLI, R.C. SASSO,H.H. WANG, D. Q.-H. WANG
CHAPTER 4 Classification, Composition and Structure of Gallstones.
Relevance of these Parameters for Clinical Presentation
and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51F. CETTA
CHAPTER 5 Natural History of Biliary Lithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67G. CADDY
CHAPTER 6 Preoperative Noninvasive Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75R. MANFREDI, S. MEHRABI, M. MOTTON, R. POZZI MUCELLI
CHAPTER 7 Three-dimensional Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93L. SOLER, R. CAHILL, J. MARESCAUX
CHAPTER 8 Endoscopic Retrograde Cholangiopancreatography
and Endoscopic Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105J. MEENAN
CHAPTER 9 Pre- and Intra-operative Diagnostic
Fibrocholangioscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115G. M. GAZZANIGA, M. FILAURO
CHAPTER 10 Intraoperative Cholangiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123M. SCHÄFER
VIII Table of Contents
CHAPTER 11 Laparoscopic Ultrasound during Laparoscopic
Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131J.-M. CATHELINE, J. ROUSSEL
CHAPTER 12 Diagnostic Flow Charts for Biliary Lithiasis . . . . . . . . . . . . . . . . . . . . . . . 143E. LERMITE, P. PESSAUX
CHAPTER 13 Medical Treatment of Gallstone Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 149P. PORTINCASA, A. MOSCHETTA, F. PUGLISI, L. BORRACCINO, D.Q.-H. WANG
CHAPTER 14 Surgical Treatment of Cholelithiasis: Exclusion Criteria . . . . . 159G. PAOLO SPINA, G. GAVERINI
CHAPTER 15 Anesthesia in Biliary Lithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175A.M. KOIVUSALO
CHAPTER 16 Cholecystectomy Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185J.-F. GIGOT, C. HUBERT, B. NAVEZ
CHAPTER 17 Robot-assisted Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209C. SOLANO, M. GUALTIEROTTI, R. CAHILL, J. MARESCAUX
CHAPTER 18 Day Surgery Laparoscopic Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . 217M. PLANELLS ROIG, R. GARCIA ESPINOSA, C. ARNAL BERTOMEU, A. SANAHUJA SANTAFÉ, M. CARRAU GINER, M. CERVERA DELGADO, J. BUENO LLEDÓ, E. ESCARTI CARBONELL, A. SANCHEZ SALAS
CHAPTER 19 Diagnosis and Treatment of Acute Cholecystitis . . . . . . . . . . . . . . . . 237G. BORZELLINO, E. SALADINO, M. DE LUCA, C. CORDIANO
CHAPTER 20 Incidental Carcinoma of the Gallbladder . . . . . . . . . . . . . . . . . . . . . . . . . . 249L. CAPUSSOTTI, A. MURATORE, A. FERRERO, L. VIGANÒ
CHAPTER 21 Complications of Laparoscopic Cholecystectomy . . . . . . . . . . . . . . . 255G. NUZZO, F. GIULIANTE, F. ARDITO
CHAPTER 22 Clinical Pictures of Common Bile Duct Stones . . . . . . . . . . . . . . . . . . . 311J. TRECKMANN, C.E. BROELSCH, A. PAUL
CHAPTER 23 Synchronous Treatment of Common Bile Duct
Stones by Laparotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317O. CHAPUIS, B. MALGRAS, A. BOUIX
CHAPTER 24 Cholecystocholedocholithiasis: Two-stage Treatment . . . . . . . 325M. MORINO, A. AREZZO
CHAPTER 25 Synchronous Treatment of Common Bile Duct Stones
by Laparoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341A.M. PAGANINI, A. ROTUNDO, E. LEZOCHE
Table of Contents IX
CHAPTER 26 Rendez-vous Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351G. BORZELLINO, E. SALADINO, F. LOMBARDO, C. CORDIANO
CHAPTER 27 Flow Chart for the Treatment of CBDS
and Critical Comparison of Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357D. MARTIN, I. MARTIN
CHAPTER 28 Common Bile Duct Stones in Cholecystectomized
Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365C. SCIUMÈ, G. GERACI, F. PISELLO, T. FACELLA, F. LI VOLSI, G. MODICA
CHAPTER 29 Acute Biliary Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383G. BORZELLINO, E. SALADINO, A.M. MINICOZZI, C. CORDIANO
CHAPTER 30 Incidence and Management of Mirizzi Syndrome . . . . . . . . . . . . . . 393M.K. MÜLLER, F. LÖHLEIN, M. SCHÄFER
CHAPTER 31 Biliary Lithiasis in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401C. ESPOSITO, M. DE MARCO, C. DELLA CORTE, R. IORIO, P. VAYRO, A. SETTIMI
CHAPTER 32 Biliary Lithiasis in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409P. SUNGLER, H. STEINER
CHAPTER 33 Biliary Lithiasis and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415M. RIZZELLO, G. CASELLA, F. ABBATINI, G. SILECCHIA, N. BASSO
CHAPTER 34 Biliary Lithiasis in Patients with Gastroesophageal
Reflux (Acid and Alkaline) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425A. DEL GENIO, G. ROSSETTI, V. MAFFETTONE, V. NAPOLITANO, G. DEL GENIO,L. BRUSCIANO, F. PIZZA, M. DI MARTINO, S. TOLONE
CHAPTER 35 Hepatic Cirrhosis and Biliary Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435P. PESSAUX, E. LERMITE
CHAPTER 36 Biliary Stones and Gastrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439G. DE MANZONI, S. GIACOPUZZI, G. BORZELLINO, C. CORDIANO
CHAPTER 37 Biliary Ileus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449B. NAVEZ, H.-D. LAM, J.-F. GIGOT
CHAPTER 38 Clinical Pictures of Intrahepatic Lithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . 455A. RUZZENENTE, C. ZUGNI, A. GUGLIELMI
CHAPTER 39 Treatment of Intrahepatic Lithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467Y. NIMURA
CHAPTER 40 Extracorporeal Shock Wave Treatment
of Gallbladder Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479L. CARRILHO-RIBEIRO, M. CARNEIRO DE MOURA
CHAPTER 41 Shock Wave for Main Bile Duct Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489S. AMPLATZ, F. CHILOVI
CHAPTER 42 Acute Gallstone Cholangitis: Clinical Pictures,
Diagnosis and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497L. RONCORONI, L. SARLI, G. REGINA
SUBJECT INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
X Table of Contents
FRANCESCA ABBATINI
Department of Surgery Paride StefaniniPoliclinico Umberto IUniversity of Rome La SapienzaRome, Italy
STEFANO AMPLATZ
Division of GastroenterologyCentral Hospital of BolzanoBolzano, Italy
FRANCESCO ARDITO
Department of SurgeryHepatobiliary Surgery UnitCatholic University of the Sacred HeartSchool of MedicineRome, Italy
ALBERTO AREZZO
Department of SurgeryMinimally Invasive Surgery CentreUniversity of TurinTurin, Italy
NICOLA BASSO
Department of Surgery Paride StefaniniPoliclinico Umberto IUniversity of Rome La SapienzaRome, Italy
CONSUELO ARNAL BERTOMEU
ICAD (Instituto de Cirugía Generaly Aparato Digestivo)Quiron ClinicValencia, Spain
LUIGI BORRACCINO
Department of Internal Medicine and Public MedicineClinica Medica A. MurriUniversity of Bari Medical SchoolBari, Italy
GIUSEPPE BORZELLINO
Department of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
CONTRIBUTORS
ANNE BOUIXDepartment of General SurgeryPercy Military HospitalClamart, France
CHRISTOPH E. BROELSCHClinic for General,Visceral and Transplantation SurgeryUniversity Hospital of EssenEssen, Germany
LUIGI BRUSCIANOI Division of Generaland Gastrointestinal SurgerySecond University of NaplesNaples, Italy
JOSE BUENO LLEDÓICAD (Instituto de Cirugía Generaly Aparato Digestivo)Quiron ClinicValencia, Spain
GRANT CADDYDepartment of GastroenterologyUlster HospitalBelfast, Northern Ireland (G.B.)
RONAN CAHILLIRCAD/EITS InstituteStrasbourg, France
LORENZO CAPUSSOTTIDepartment of SurgeryHepato-Pancreato-Biliary UnitHospital MaurizianoTorino, Italy
MIGUEL CARNEIRO DE MOURACentre of GastroenterologyUniversity Hospital of Santa MariaLisbon, Portugal
MIGUEL CARRAU GINERDepartment of AnaesthesiologyICAD (Instituto de Cirugía General y Aparato Digestivo)Quiron ClinicValencia, Spain
LUÍS CARRILHO-RIBEIROCentre of GastroenterologyUniversity Hôpitaux de Santa MariaLisbon, Portugal
GIOVANNI CASELLADepartment of Surgery Paride StefaniniPoliclinico Umberto IUniversity of Rome La SapienzaRome, Italy
JEAN-MARC CATHELINEDepartement of Digestive SurgeryHospital AvicenneAssistance Publique-Hôpitaux de ParisBobigny, Paris, France
MARIA CERVERA DELGADOICAD (Instituto de Cirugía General y Aparato Digestivo)Quiron ClinicValencia, Spain
FRANCESCO CETTADepartment of SurgeryInteruniversity Center for Researchin Hepatobiliary DiseaseUniversity of SienaSiena, Italy
OLIVIER CHAPUISDepartment of General SurgeryPercy Military HospitalClamart, France
FAUSTO CHILOVIDivision of GastroenterologyCentral Hospital of BolzanoBolzano, Italy
CLAUDIO CORDIANODepartment of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
ALBERTO DEL GENIOI Division of General and Gastrointestinal SurgerySecond University of NaplesNaples, Italy
GIANMATTIA DEL GENIOI Division of General and Gastrointestinal SurgerySecond University of NaplesNaples, Italy
CLAUDIA DELLA CORTEDepartment of PediatricsFederico II UniversityNaples, Italy
MANUELA DE LUCADepartment of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
GIOVANNI DE MANZONIDepartment of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
MARIANNA DE MARCODepartment of PediatricsFederico II UniversityNaples, Italy
AGOSTINO DI CIAULADivision of Internal MedicineHospital of BisceglieBisceglie (Bari), Italy
MARIA DI MARTINOI Division of Generaland Gastrointestinal SurgerySecond University of NaplesNaples, Italy
EDUARDO ESCARTI CARBONELLDepartment of Gastroenterology ICAD(Instituto de Cirugía Generaly Aparato Digestivo)Quiron ClinicValencia, Spain
CIRO ESPOSITODepartment of PediatricsFederico II UniversityNaples, Italy
TIZIANA FACELLADepartment of SurgeryUniversity of PalermoPalermo, Italy
ALESSANDRO FERRERODepartment of SurgeryHepato-Pancreato-Biliary UnitHospital MaurizianoTorino, Italy
MARCO FILAURODepartment of SurgeryHPB UnitGalliera HospitalGenoa, Italy
RAFAEL GARCIA ESPINOSAICAD (Instituto de Cirugía General y Aparato Digestivo)Quiron ClinicValencia, Spain
XII Contributors
GIACOMO GAVERINIDepartement of SurgeryHospital FatebenefratelliMilan, Italy
GIAN M. GAZZANIGADepartment of SurgeryHPB UnitGalliera HospitalGenoa, Italy
GIROLAMO GERACIDepartment of SurgeryUniversity of PalermoPalermo, Italy
SIMONE GIACOPUZZIDepartment of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
JEAN-FRANÇOIS GIGOTDivision of Hepatobiliary and Pancreatic SurgeryDepartment of Abdominal Surgeryand TransplantationSaint-Luc University HospitalBrussels, Belgium
FELICE GIULIANTEDepartment of SurgeryHepatobiliary Surgery UnitCatholic University of the Sacred HeartSchool of MedicineRome, Italy
MONICA GUALTIEROTTIIRCAD/EITS InstituteStrasbourg, France
ALFREDO GUGLIELMIDepartment of Surgery and GastroenterologyG.B. Rossi HospitalUniversity of VeronaVerona, Italy
CATHERINE HUBERTDivision of Hepatobiliary and Pancreatic SurgeryDepartment of Abdominal Surgeryand TransplantationSaint-Luc University HospitalBrussels, Belgium
RAFFAELE IORIODepartment of PediatricsFederico II UniversityNaples, Italy
ANNA M. KOIVUSALODepartment of Anaesthesia and Intensive CareLiver Surgeryand Transplantation ClinicUniversity HospitalHelsinki, Finland
HWAI-DING LAMDepartment of Abdominal SurgeryHospital Saint JosephCharleroi (Gilly), Belgium
EMILIE LERMITEDepartment of Digestive SurgeryCHU AngersAngers, France
EMANUELE LEZOCHEDepartment of General Surgery and Organ Transplantation P. StefaniniAzienda Policlinico Umberto IUniversity of Rome La SapienzaRome, Italy
FRANCESCO LI VOLSIDepartment of SurgeryUniversity of PalermoPalermo, Italy
FRAUKE LÖHLEINDepartment of Visceral and Transplantation SurgeryUniversity Hospital of ZurichZurich, Switzerland
FRANCESCO LOMBARDODepartment of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
VINCENZO MAFFETTONEI Division of General and Gastrointestinal SurgerySecond University of NaplesNaples, Italy
BRICE MALGRASDepartment of General SurgeryPercy Military HospitalClamart, France
RICCARDO MANFREDIDepartment of RadiologyUniversity of VeronaG.B. Rossi University HospitalVerona, Italy
JACQUES MARESCAUXIRCAD/EITS InstituteStrasbourg, France
Contributors XIII
DAVID MARTINDepartment of Upper GI Surgery Concord and Royal Prince Alfred HospitalsSydney, Australia;Copenhagen Trial UnitCochrane Hepato-Biliary GroupCopenhagen, Denmark
IAN MARTINDepartment of Upper GI SurgeryPrincess Alexandra HospitalBrisbane, Australia
JOHN MEENANDepartment of GastroenterologyGuy’s and St. Thomas’s HospitalLondon, United Kingdom
SARA MEHRABIDepartment of RadiologyUniversity of VeronaG.B. Rossi University HospitalVerona, Italy
ANNA M. MINICOZZIDepartment of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
GIUSEPPE MODICADepartment of SurgeryUniversity of PalermoPalermo, Italy
MARIO MORINODepartment of SurgeryMinimally Invasive Surgery CentreUniversity of TurinTurin, Italy
ANTONIO MOSCHETTADepartment of Internal Medicine and Public MedicineClinica Medica A. MurriUniversity of Bari Medical SchoolBari, Italy;Department of TranslationalPharmacologyConsorzio Mario Negri SudSanta Maria Imbaro (Chieti), Italy
MASSIMILIANO MOTTONDepartment of RadiologyUniversity of VeronaG.B. Rossi University HospitalVerona, Italy
PHILIPPE MOURET
Professor of SurgeryLyon, France
MARKUS K. MÜLLER
Department of Visceraland Transplantation SurgeryUniversity Hospital of ZurichZurich, Switzerland
ANDREA MURATORE
Department of SurgeryHepato-Pancreato-Biliary UnitHospital MaurizianoTorino, Italy
VINCENZO NAPOLITANO
I Division of Generaland Gastrointestinal SurgerySecond University of NaplesNaples, Italy
BENOIT NAVEZ
Department of Abdominal SurgeryHospital Saint JosephCharleroi (Gilly), Belgium
YUJI NIMURA
Department of Digestive SurgeryAichi Cancer CenterNagoya, Japan
GENNARO NUZZO
Department of SurgeryHepatobiliary Surgery UnitCatholic University of the Sacred HeartSchool of MedicineRome, Italy
ALESSANDRO M. PAGANINI
Department of General Surgery and Organ Transplantation P. StefaniniAzienda Policlinico Umberto IUniversity of Rome La SapienzaRome, Italy
ANDREAS PAUL
Clinic for GeneralVisceral and Transplantation SurgeryUniversity Hospital of EssenEssen, Germany
PATRICK PESSAUX
Department of Hepatic Surgery and TransplantationHospital of HautepierreStrasbourg, France
XIV Contributors
FRANCO PISELLODepartment of SurgeryUniversity of PalermoPalermo, Italy
FRANCESCO PIZZAI Division of General and Gastrointestinal SurgerySecond University of NaplesNaples, Italy
MANUEL PLANELLS ROIGICAD (Instituto de Cirugía Generaly Aparato Digestivo)Quiron ClinicValencia, Spain
DANIELA PONTRELLIDepartment of Internal Medicineand Public MedicineClinica Medica A. MurriUniversity of Bari Medical SchoolBari, Italy
PIERO PORTINCASADepartment of Internal Medicineand Public MedicineClinica Medica A. MurriUniversity of Bari Medical SchoolBari, Italy
ROBERTO POZZI MUCELLIDepartment of RadiologyUniversity of VeronaG.B. Rossi University HospitalVerona, Italy
FRANCESCO PUGLISISection of SurgeryDepartment of Emergencyand Transplant Organs (DETO)University of Bari Medical SchoolBari, Italy
GABRIELE REGINADepartment of Surgical SciencesSection of General Surgical Clinicsand Surgical TherapyParma University Medical SchoolParma, Italy
MARIO RIZZELLODepartment of Surgery P. StefaniniPoliclinico Umberto IUniversity of Rome La SapienzaRome, Italy
LUIGI RONCORONI
Department of Surgical SciencesSection of General Surgical Clinicsand Surgical TherapyParma University Medical SchoolParma, Italy
GIANLUCA ROSSETTI
I Division of Generaland Gastrointestinal SurgerySecond University of NaplesNaples, Italy
ADRIANA ROTUNDO
Department of General Surgery and Organ Transplantation P. StefaniniAzienda Policlinico Umberto IUniversity of Rome La SapienzaRome, Italy
JOËL ROUSSEL
Hospital AvicenneAssistance Publique-Hôpitaux de ParisBobigny, Paris, France
ANDREA RUZZENENTE
Department of Surgeryand GastroenterologyG.B. Rossi HospitalUniversity of VeronaVerona, Italy
EDOARDO SALADINO
Department of SurgeryUniversity Hospital O.C.M. Borgo TrentoUniversity of VeronaVerona, Italy
ANGEL SANAHUJA SANTAFÉ
ICAD (Instituto de Cirugía General y Aparato Digestivo)Quiron ClinicValencia, Spain
AFRICA SANCHEZ SALAS
ICAD (Instituto de Cirugía Generaly Aparato Digestivo)Quiron ClinicValencia, Spain
LEOPOLDO SARLI
Department of Surgical SciencesSection of General Surgical Clinicsand Surgical TherapyParma University Medical SchoolParma, Italy
Contributors XV
ROSA C. SASSO
Department of Internal Medicineand Public MedicineClinica Medica A. MurriUniversity of Bari Medical SchoolBari, Italy
STEFAN SAUERLAND
Institute for Researchin Operative MedicineUniversity of Witten/HerdeckeCologne, Germany
MARKUS SCHÄFER
Department of Visceral and Transplantation SurgeryUniversity Hospital of ZurichZurich, Switzerland
CARMELO SCIUMÉ
Department of SurgeryUniversity of PalermoPalermo, Italy
ALESSANDRO SETTIMI
Department of PediatricsFederico II UniversityNaples, Italy
GIANFRANCO SILECCHIA
Department of Surgery Paride StefaniniPoliclinico Umberto IUniversity of Rome La SapienzaRome, Italy
CINTHYA SOLANO
IRCAD/EITS InstituteStrasbourg, France
LUC SOLER
IRCAD/EITS InstituteStrasbourg, France
G. PAOLO SPINA
Department of SurgeryHospital FatebenefratelliMilan, Italy
HORST STEINERDepartment of GynecologyParacelsus Medical UniversitySalzburg, Austria
PAUL SUNGLERDepartment of SurgeryParacelsus Medical UniversitySalzburg, Austria
SALVATORE TOLONEI Division of Generaland Gastrointestinal SurgerySecond University of NaplesNaples, Italy
JÜRGEN TRECKMANNClinic for GeneralVisceral and Transplantation SurgeryUniversity Hospital of EssenEssen, Germany
PIETRO VAYRODepartment of PediatricsFederico II UniversityNaples, Italy
LUCA VIGANÒDepartment of SurgeryHepato-Pancreato-Biliary UnitHospital MaurizianoTurin, Italy
HELEN H. WANGGastroenterology DivisionBeth Israel Deaconess Medical CenterDepartment of MedicineHarvard Medical SchoolBoston, Massachusetts, USA
DAVID Q.-H. WANGGastroenterology DivisionBeth Israel Deaconess Medical CenterDepartment of MedicineHarvard Medical SchoolBoston, Massachusetts, USA
CHIARA ZUGNIDepartment of Surgery and GastroenterologyG.B. Rossi HospitalUniversity of VeronaVerona, Italy
XVI Contributors