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Preface

The fifth edition of this text, Blumgart's Surgery of the Liver, Biliary Tract, and Pancreas, represents the most significant change since the first edition appeared in 1988. Specifically, the current edition marks the first time in three decades that Leslie H. Blumgart, MD, has not had a major hand in its creation. With his retirement from clinical practice, stewardship of the textbook, which has evolved into one of the most influential in the field, has been passed to the next generation of HPB surgeons, many of whom Leslie Blumgart has trained personally and all of whom he has influenced greatly. The title change is a fitting reminder of his status as a pioneering HPB surgeon and recognizes the many contributions he has made to the specialty.The fifth edition continues the tradition of using associate editors to cover, in a comprehensive fashion, the extraordinary growth of knowledge and advances that have taken place since the publication of the previous edition. The associate editors are all internationally renowned experts in the field and bring great insight based on extensive personal experience. Dr. Jacques Belghiti, of Paris, France, and Dr. William Chapman, of St. Louis, Missouri, assumed primary responsibility for sections dealing largely with hepatic resection and transplantation; these chapters reflect their substantial contributions in these areas. Dr. Markus Büchler, of Heidelberg, Germany, brought his extensive background in pancreatic disease management to provide a comprehensive update to the pancreas section. A great debt of gratitude is owed to my colleagues in the Department of Surgery at Memorial Sloan-Kettering Cancer Center: Dr. Ronald DeMatteo, whose basic science experience helped reinvigorate the physiology section, and Dr. Michael D’Angelica, who brought his considerable clinical experience to the chapters on biliary tract disease. A special note of thanks goes to Dr. Lucy Hann, who has been involved with liver, hepatobiliary, and pancreatic radiology for many years. Before her recent retirement, she was one of the leading practitioners of diagnostic ultrasound in the United States.

Although the organization of the book has been changed, we have maintained the general format of covering all surgical aspects of the management of hepatobiliary and pancreatic disorders. Radiologic, endoscopic, and other nonsurgical approaches are also presented in detail and are highlighted when they represent the preferred treatment. The contributors are specialists in their fields and have been asked to discuss the subject from the point of view of surgical management and to relate their views to the opinions of others. Authors with conflicting opinions have, in some cases, been chosen to give the reader an opportunity to assess divergent views. Overlap between chapters, when appropriate, was encouraged: first to allow each contribution to represent an encapsulated account that stands on its own for the reader who wishes to consult the book as a reference, and second, to allow the display of different nuances of approach to particularly difficult problems.

In addition to the organizational changes, a number of modifications have been made throughout this text. Several additions have been made, including chapters on embryologic development (to complement the anatomy chapter), hepatic fibrogenesis, and minimally invasive resection techniques. Advances in our understanding of molecular pathogenesis of neoplastic disease have been emphasized in the physiology section, and chapters highlighting ablative techniques and advances in chemotherapy, particularly as they affect the results of resection, have been added. Some chapters have been split to allow expansion on new developments, and others have been combined or eliminated. An important feature is the inclusion of considerable technical detail so that major sections of this book can be used, in conjunction with the videos available on the text's Expert Consult site, as an atlas of technique.

The initial section of the book is devoted to the applied anatomy of the liver and biliary tract, including its radiologic demonstration. Throughout this edition, the anatomic contributions of Claude Couinaud are recognized, and the liver anatomy and nomenclature of the various operative approaches are generally based on his descriptions. The anatomy chapter remains one of the most important in the entire edition; its detailed description of normal and variant anatomy, with radiologic illustrations, provides the essential basis for the reader to appreciate fully the discussions and illustrations of the operative approaches that follow. In recent years, there has been extraordinary refinement in the operative techniques pertaining to hepatic, biliary, and pancreatic resection, and these are covered in special detail. Likewise, the entire section on liver transplantation and its complications and results has been expanded to cover new developments in the field.

In summary, this work attempts to include all aspects of the anatomy, pathology, diagnosis, and surgical and nonsurgical therapeutic approaches to hepatobiliary and pancreatic disorders. The aim is to provide a text valued equally by the trainee surgeon and the established HPB surgeon as well as physicians in related disciplines. We have attempted to enlist new contributors throughout the book to give latitude to conflicting opinions and to allow the reader to form an individual approach based on contemporary opinions.

I again express my thanks to the co-editors who have collaborated with me in this endeavor and who join me in the hope that this book will prove of value as an account of the current “state of the art” in the surgical aspects of hepatobiliary and pancreatic disease as well as a stimulus to those interested in further study of the many unresolved problems that require investigation.

This book has seen the establishment and maturation of the specialty of hepatobiliary and pancreatic surgery. This evolution is due to the efforts of Leslie H. Blumgart and his contemporaries, whose vision, courage, and skill have made the field of HPB surgery what it is today. It is with pleasure that we dedicate this work to Leslie H. Blumgart and the small band of pioneering surgeons.

W.R. Jarnagin

New York, 2012