Critical care challenges in hepatobiliary and pancreatic surgery

PURPOSE OF REVIEW: The aim of this review is to provide an update on some key aspects of the perioperative management of patients undergoing hepatopancreatobiliary (HPB) surgery. RECENT FINDINGS: Recent studies underline the importance of performing these surgeries in specialized centers to improve outcomes. In these centers of excellence, the high volume of HPB-performed surgery, the existence of enhanced recovery after surgery (ERAS) programs, and the use of minimally invasive surgery techniques all help to improve patient outcomes. In liver surgery, the main evolving challenges remaining are intraoperative bleeding control, and postoperative complications, mainly represented by the risk of posthepatectomy liver dysfunction, for which intraoperative and postoperative strategies have recently been evaluated and could improve patient prognosis. In pancreatic surgery, the main issues raised in the review are the prevention and treatment of pancreatic fistula, and the risk and prevention of surgical site infection. SUMMARY: This review highlights recent developments in perioperative care for HPB surgery. This highlights the importance of specialized centers equipped to prevent and manage the specific complications associated with these procedures. Further studies are needed to clarify which intraoperative and postoperative strategies are most beneficial for postoperative outcome.