Decision-Making in Hepatobiliary and Pancreatic Surgery: Acute Care Surgeon’s Perspective

Decision-making in patients with complex hepatobiliary and pancreatic pathology is a challenging one even for an experienced acute care surgeon. In this chapter, we have covered four common pathologies encountered by an acute care surgeon: management of acute pancreatitis, approach to difficult gallbladder, surgical techniques for managing pancreatic trauma, and management of liver trauma. Necrotic infected acute pancreatitis carries a mortality of about 30%, and we detail updated management techniques in this chapter. Cholecystectomy can be a daunting procedure in cases of difficult gallbladder, and we have described evidence-based techniques and approach to such challenging cases and tricks to avoid common bile duct injury. Pancreatic trauma is rare but, if suspected, the surgeon should have low threshold for consideration for repeat or further advanced imaging and the management depends on the grade of injury. In the case of blunt trauma, liver is the most commonly injured abdominal organ and in majority of those can be managed nonoperatively.