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