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In patients with occupational cholangiocarcinoma, Kinoshita and colleagues report a carcinogenic process consisting of chronic bile duct injury with DNA damage that occured within almost all of the large bile ducts, the induction of pre- or early cancerous lesions such as BilIN and IPNB, and the development of invasive carcinoma.

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With the aim to assess the impact of epidural anesthesia dysfunction on outcomes after pancreatectomy, Sugimoto and colleagues revealed an independent association between hypo-function and both pancreas-related and non-pancreas-related complications, and between hyper-function and non-pancreas-related complications. Increasing the success rate of epidural anesthesia is key to improve outcomes after pancreatectomy.

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The authors performed a prospective, multicenter, ramdomized controlled study to investigate the efficacy of TachoSil® patches in preventing pancreatic fistula, the most frequent and serious complication after distal pancreatectomy, for which effective prevention and management methods remain lacking. The patch did not reduce the incidence of postoperative pancreatic fistula.

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Komorowski and colleagues review their experience with perihepatic packing, temporary abdominal closure and delayed biliary reconstruction in 20 patients with massive uncontrollable bleeding, secondary coagulopathy and bowel edema during liver transplantation. The results of the use of this technique in desperate surgical situations are encouraging with 18 long-term survivors.

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Certain lipid-lowering drugs increase bile lithogenicity. Kishikawa and colleagues investigated whether long-term administration of ezetimibe, a hypocholesterolemic agent that inhibits intestinal cholesterol absorption, alters bile lithogenicity in patients with hepatobiliary disease. Their findings indicate that ezetimibe improves lipid metabolism without altering bile lithogenicity, suggesting its safety in management of dyslipidemias.

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To address the lack of an established pharmacologic treatment, Yamamoto and colleagues set out to assess the efficacy of ursodeoxycholic acid in preventing recurrence of common bile duct stones after endoscopic removal in a multi-center ramdomized trial. Their findings indicate that ursodeoxycholic acid administration is a promising preventive treatment strategy.

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Minimally invasive approaches in hepatic surgery may improve postoperative outcomes without compromising oncological results, but require expertise in both hepatic and advanced laparoscopic surgery. Cherqui and colleagues present a video depicting technical details for safely performing totally laparoscopic left hepatectomy in the setting of hepatocellular carcinoma in cirrhotic liver.