Hepatobiliary surgery: Indications, evaluation, and outcomes

Complex surgical intervention for liver disease is a relatively new addition in medical practice. Early attempts at surgical resection were associated with high rates of total morbidity. Mirroring the experience in cardiac surgery, advances in physiology and anatomy, new technology, standardized surgical techniques, and improvements in perioperative management have all contributed to the current reliability and success associated with hepatic surgery. While hepatic surgery continues to be mostly performed in larger centers, hepatobiliary programs have proliferated so that access to high-quality liver surgical care is now available in virtually all major metropolitan areas in North America. Centers of excellence are generally characterized by a higher volume surgical procedures and a commitment to multidisciplinary specialty care. Hepatology, critical care medicine, interventional radiology, and diagnostic radiology are some of the core disciplines that are required to support a hepatobiliary program.