文档介绍：Surg Clin N Am 88 (2008) xiii–xv
Foreword
Ronald F. Martin, MD
Consulting Editor
There are many reasons to present an issue of the Surgical Clinics of
North America on surgery of the biliary tract, and many of them are contra-
dictory at some level. Nearly all general surgeons perform biliary tract sur-
gery to some degree, and progressively fewer general surgeons seem
comfortable with all aspects of biliary surgery. The historic progression of
this ‘‘comfort dissociation’’ is fairly easy to trace but, in my opinion, difficult
pletely understand. And, sadly, it may reflect a disturbing trend in
our industry.
There are three main influences that have drastically altered the scope
and distribution of biliary surgical practice: (1) the advent and wide distri-
bution of available petent flexible fiber optic endoscopic retrograde
cholangiopancreatography (ERCP), (2) the rapid and plete tech-
nical shift to laparoscopic cholecystectomy, and (3) the Wizard of Oz factor.
Although ERCP was developed in the 1970s, several years passed before
it became widely available, and it remains readily available in far fewer fa-
cilities than laparoscopic cholecystectomy. ERCP is increasingly being per-
formed by gastroenterologists or surgeons with advanced training beyond
conventional residencies or fellowships. The clinical capability of advanced
practice endoscopists has altered the conventional practice of biliary surgery
in two major ways. First, it has provided a nonoperative solution to many
problems that in the past were predominantly managed by surgeons. Sec-
ond, it has created a patient geographic dislocation in that even in patients
in whom endoscopic procedures do not resolve their problem, it is highly
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doi:. surgical.
xiv FOREWORD
unlikely that they will be transferred back to the referring institution rather
than stay at the ‘‘higher echelon’