DOI:10.1111/j.1477-2574.2010.00201.

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ORIGINAL ARTICLE

Surgical management of acute pancreatitis in Italy: lessons from a

prospective multicentre study
Paolo De Rai1, Alessandro Zerbi2, Laura Castoldi1, Claudio Bassi3, Luca Frulloni4, Generoso Uomo5, Armando Gabbrielli4,
Raffaele Pezzilli6, Giorgio Cavallini4, Valerio Di Carlo7 & the ProInf-AISP (Progetto Informatizzato Pancreatite Acuta,
Associazione Italiana per lo Studio del Pancreas [Computerized Project on Acute Pancreatitis, Italian Association for the
Study of the Pancreas]) Study Group*
1
Department of Surgery and Emergency Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS [Institute for Scientific Care and
Treatment]) Ca' Granda – Ospedale Maggiore Policlinico, Milan, Italy, 2Pancreatic Surgery Section, Department of Surgery, IRCCS Istituto Clinico Humanitas
(Humanitas Clinical Institute), Rozzano, Italy, 3Department of Surgery, University of Verona, Verona, Italy, 4Department of Gastroenterology, University of
Verona, Verona, Italy, 5Department of Internal Medicine, Cardarelli Hospital, Naples, Italy, 6Pancreas Unit, Department of Digestive Diseases and Internal
Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy and 7Department of Surgery, IRCCS San Raffaele, Milan, Italy

Abstract hpb_201 597..604

Objective: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess
compliance with international guidelines.
Methods: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed.
Results: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy
was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejun-
ostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714
patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212
patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic
retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-
seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset
of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the
first admission. There were no deaths.
Discussion: The results indicate poor compliance with published guidelines. In severe pancreatitis, early
surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of
patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks
of the onset of pancreatitis.

Keywords
surgery, acute pancreatitis

Received 22 February 2010; accepted 7 June 2010

Correspondence
Paolo De Rai, Department of Surgery and Emergency Surgery, Fondazione IRCCS Cà Granda – Ospedale
Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy. Tel: + 39 2 5503 3221. Fax: + 39 2 5503
3468. E-mail: pderai@policlinico.mi.it

Introduction
The surgical treatment of mild and severe acute pancreatitis (AP)
has been established in several international evidence-based
guidelines.1–4
In mild biliary pancreatitis, cholecystectomy on the same admis-
sion or within 2 weeks of discharge is recommended for patients
*See Appendix for members of the ProInf-AISP Study Group.
who are fit enough to undergo surgery.1 In those who are too frail to
be operated on, a definitive endoscopic sphincterotomy is recom-
mended.1 In severe AP, current indications for surgery include the
presence of infected pancreatic necrosis, extensive sterile necrosis
in patients in whom symptoms have failed to resolve despite
maximal conservative treatment or in patients who develop cata-
strophic complications related to pancreatic necrosis such as bleed-
ing, visceral perforation or infarction. In addition, it is considered

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Table 1 Characteristics of surgical treatment in severe and mild pancreatitis compared with the recommendations of guidelines
Variables Recommendations
Severe pancreatitis
Indications for surgery • Infected pancreatic necrosis1,2,4
• Sterile necrosis with multiple organ failure without improvement despite
maximal therapy2
• Early surgery within 14 days is not recommended unless there are
specific indications2
Timing of surgery After 3–4 weeks2
Type of surgical intervention Necrosectomy1,2,4
Type of postoperative lavage (intermittent Not mentioned
vs. continuous)
Timing of drainage removal Not mentioned
Surgical jejunostomy Not mentioned
Timing of cholecystectomy in severe acute Delayed after recovery1,2
pancreatitis
Preoperative assessment of acute pancreatitis The surgical indication depends on the clinical picture (evidence of
by computed tomography sepsis) and demonstration by computed tomography of pancreatic or
peripancreatic necrosis1
Mild pancreatitis
Timing of cholecystectomy • As soon as the patient has recovered and during the same hospital admission1–4
• Within 2 weeks of discharge1
Type of cholecystectomy (open vs. laparoscopic) Not mentioned

that delaying surgical intervention in severe AP until at least 2
weeks after presentation is advantageous.1–4 Several studies from
different countries have recently highlighted poor compliance with
guidelines for the treatment of AP.5–9 However, most of the data
reported in these studies were based on questionnaires sent to
specialists (surgeons, gastroenterologists, etc.) with the aim of
evaluating their ideal therapeutic approach to AP. Recently, a large
multicentre study was performed in Italy under the auspices of the
Associazione Italiana per lo Studio del Pancreas (AISP [Italian
Association for the Study of the Pancreas]). This group has previ-
ously published its results with regard to conservative, endoscopic
and surgical treatments.10,11
The aim of this study was to assess compliance with interna-
tional guidelines with respect to indications, timing and type of
surgery for patients presenting with both mild biliary pancreati-
tis and AP of all aetiologies in Italian centres that had contrib-
uted to the multicentre prospective study on the treatment of
severe AP in Italy.
Materials and methods
The AISP study involved 56 centres distributed uniformly
throughout Italy. All patients admitted with AP during the
period from December 2001 to November 2003 were included.
The diagnosis of AP was based on clinical (pancreatic-type pain)
and biochemical (three-fold increase in serum amylase or lipase)
findings, and/or morphological pancreatic changes detected by
ultrasonography (US), computed tomography (CT) or magnetic
resonance imaging (MRI). The disease was classified as mild or
severe according to the Atlanta criteria, as well as sequelae of AP
(fluid collections, pseudocysts, fistulae).12,13 Data were collected
using a software programme which included 530 items, of which
61 were surgical, designed by members of the study group (gas-
troenterologists, endoscopists and surgeons) and sent to each
participating centre. The data were collected and tabulated
centrally, and a thorough monitoring process was carried out
during the study. At the end of the recruitment phase, the com-
pleteness and congruence of each patient’s chart were assessed in
order to exclude patients for whom data were incomplete or
inconsistent.
The pancreatitis was assumed to be biliary in aetiology if gall-
stones were seen on US or CT or if two of the following abnormal
laboratory tests were present: alkaline phosphatase level >125 U/l;
alanine aminotrasferase (ALT) level >75 U/l, or bilirubin >2.3 mg/
dl.14 The gallbladder was defined as abnormal if gallstones or signs
of inflammation were present on US. Variables assessed for evalu-
ating surgical treatment and adherence to international guidelines
are reported in Table 1. In addition, postoperative outcomes
including hospital stay, complications and the need for repeated
surgery were assessed.
Data were presented as medians, ranges and frequencies.
Statistical analysis was carried out using the Mann–Whitney
U-test and the chi-squared non-parametric test. Data were pro-
cessed using spss Version 10 (SPSS, Inc., Chicago, IL, USA).
P < 0.05 was considered to represent a statistically significant
difference.

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Table 2 Characteristics of 167 patients with severe pancreatitis: a comparison of 29 patients undergoing necrosectomy or simple drainage
and 138 non-operated patients
Necrosectomy or Non-operated P-value
drainage patients patients
(n = 29) (n = 138)
Sex, male/female 19/10 74/64 0.241
Median age, years 68.0 69.5 0.166
Aetiological factors, n (%)
Biliary 17 (58.6) 85 (61.6) 0.879
Alcohol 2 (6.9) 12 (8.7) 0.751
Unknown 6 (20.7) 31 (22.5) 0.770
Other 4 (13.8) 10 (7.2) 0.184
Glasgow score 4 4 0.920
Multiple organ failure 10 0
Necrosis 8 0
Endoscopic retrograde cholangiopancreatography 6 (20.7) 30 (21.7) 0.657
Cholecystectomy 18 (62.1) 19 (13.8) <0.01
Median hospital stay, days 46 22 <0.01
Mortality, n (%) 6 (20.7) 26 (18.8) 0.818
Sequelae,a n (%) 13 (44.8) 66 (47.8) 0.952
a
Fluid collection, pseudocyst, fistula

Results patients necrosectomy was associated with closed postoperative

During the study period, 1173 patients met the inclusion criteria,
of whom 167 (14.2%) were diagnosed with severe AP. Twenty-
nine (17.4%) of these 167 patients subsequently underwent pan-
creatic surgery. Of the 1006 (85.8%) patients who presented with
mild AP, 802 (79.7%) demonstrated disease of biliary aetiology;
their cases were included for further analysis.
Pancreatic surgery
Pancreatic surgery was performed in 29 of the 167 patients with
severe pancreatitis (17.4%). The characteristics of these patients
were compared with those of the remaining 138 non-operated
patients: the aetiology and severity of the pancreatitis were
similar. In the operated patients, the rate of cholecystectomy was
significantly higher than in patients with severe biliary AP
without necrosectomy submitted to delayed gallbladder removal
(Table 2).
Indications for surgery were as follows: acute abdomen in 16
patients; multiple organ failure (MOF) in 10 patients; infected
necrosis in eight patients, and sterile necrosis in three patients.
More than one indication was present in 18 patients.
Surgery was performed at a median of 2 days (range 0–64
days) after the onset of pancreatitis (Fig. 1). Seven of the 19
patients who underwent an early intervention (before day 5) had
not undergone preoperative CT scans. Open necrosectomy was
the surgical procedure chosen in 26 patients (89.7%), whereas
simple drainage was performed in the remaining three patients;
a laparostomy was performed in just one patient. In 21 of the 29
irrigation of the retroperitoneum (continuous in nine patients
and intermittent in 12). In 11 patients a feeding jejunostomy
was added. The median time to drain removal was 33 days
(range 4–148 days) after intervention. Postoperative complica-
tions occurred in 14 patients and included: infections (n = 6);
MOF (n = 6); pancreatic fistulae (n = 4); haemorrhage (n = 1);
occlusion (n = 1); pseudocyst (n = 1), and colonic fistula (n = 1).
There were six deaths, of which five resulted from pancreatic
causes and one from an extrapancreatic cause (gastrointestinal
bleeding). In the patients who underwent early surgery (i.e.
before day 5 after the onset of pancreatitis), morbidity was lower
and mortality was higher, although the differences were not sig-
nificant because of the small numbers of patients involved.
Eleven patients were discharged as cured and 12 were discharged
with sequelae (Table 3).
Elective biliary surgery
Of the 1006 patients with mild pancreatitis, 802 were diagnosed
with a biliary aetiology and included for further analysis. Of these,
88 (11.0%) patients had undergone previous cholecystectomy. In
593 (83.1%) of the remaining 714 patients, the gallbladder was
reported as abnormal on abdominal US or CT, whereas, in the 121
(16.9%) patients with a normal gallbladder, the aetiology was
classified as biliary as a result of enzymatic alterations (none of
these patients underwent cholecystectomy). Of the 593 patients
with abnormal gallbladder findings, 212 (35.7%) underwent
cholecystectomy, which was performed laparoscopically in 161

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8
7

Number of patients
5

4
3
2

1
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 >15
Number of days from the onset of pancreatitis
Figure 1 Distribution of 29 patients with severe acute pancreatitis according to days between surgery and onset of disease

Table 3 Relationships between outcome of pancreatitis and timing The postoperative course was uneventful in all patients except
of surgery (before or after day 5) two (of whom one underwent laparoscopy and the other an open
Surgery before Surgery after approach); both developed an abdominal collection.
day 5, n day 5, n
In 165 of the 212 (77.8%) patients who underwent cholecys-
Recovery 8 2 tectomy, the procedure was performed during the hospital admis-
Morphological sequelae 6 7 sion for pancreatitis. In the remaining 47 (22.2%) cases, patients
Fluid collection 4 2 were discharged and a second admission was required after a
Pseudocyst 2 2 median delay of 31 days (range 12–156 days) after the onset of
Fistula – 4 pancreatitis.
Mortality 5 1 Of the 167 patients with severe pancreatitis, 18 (10.8%)
Total no. of patients 19 10 underwent elective cholecystectomy at a median of 28 days
(range 3–133 days) after the onset of pancreatitis. The procedure
was performed laparoscopically in nine and as open surgery in
nine patients. Common duct exploration was required in two
(75.9%) patients (Fig. 2). In 17 patients with choledocholithiasis, patients. No mortality was observed; however, nine longterm
a biliary tree procedure was performed at the same time by open sequelae in seven patients (six fluid collections, four pseudocysts,
surgery in 11 patients and by laparoscopy in six. Two patients who one fistula) were reported. In a further 18 patients with severe
had undergone a previous cholecystectomy had biliary tract pancreatitis, a cholecystectomy was added to a major surgical
surgery for choledocholithiasis. procedure on the pancreas.
Preoperative endoscopic retrograde cholangiopancreatography
(ERCP) was associated with cholecystectomy in 83 (39.2%) of 212
Discussion
patients, 67 (80.7%) of whom subsequently underwent laparo-
scopic cholecystectomy. ERCP and surgery were performed a In the current study, the high rate of early surgical interventions
median of 6 days (range 1–8 days) and 10 days (range 2–14 days) associated with the absence of a preoperative CT scan in patients
after admission, respectively. with severe AP was an unexpected finding. As a consequence,
The median hospital stay was 13 days (range 3–50 days) in severe pancreatitis as an indication for surgery was lacking in these
patients undergoing cholecystectomy alone and 14 days patients; in fact, the reported indication for laparotomy was ‘acute
(range 5–44 days) in those undergoing ERCP + cholecystectomy. abdomen’ in more than 50% of the patients. Despite the fact that
In the subgroup of patients subjected to laparoscopic only 29 of 167 patients with severe pancreatitis underwent pan-
cholecystectomy + preoperative ERCP, the median hospital stay creatic surgery, a number too small to allow definitive conclusions,
was 13 days (range 4–42 days) vs. 13 days (range 3–50 days) for 10 were operated on the same day on which they were admitted.
those undergoing laparoscopic cholecystectomy alone (P = 0.701). This figure increased to 19 patients in the first 5 days after admis-
In comparison, those undergoing open surgery + preoperative sion. It is worth noting that, in this group of patients, seven
ERCP had a longer median hospital stay of 18 days (range 6–28 underwent surgery without a preoperative CT scan. Doctors
days) compared with those undergoing open surgery alone (17 caring for these patients reported that in patients with severe AP,
days, range 5–30 days) (P = 0.534). in whom no preoperative CT scan was carried out, laparotomies

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1006 patients
Mild pancreatitis
204 patients 802 patients
Non-biliary pancreatitis Biliary aetiology
88 patients 714 patients
Previous cholecystectomy Gallbladder in situ
121 patients
NORMAL gallbladder • Abnormal gallbladder ••
381 patients
No cholecystectomy
155 patients 6 patients
Laparoscopic Laparoscopic
cholecystectomy cholecystectomy +
CBD stone extraction
Figure 2 Distribution of 1006 patients with mild biliary acute pancreatitis, according to gallbladder characteristics and type of biliary surgery
performed. •Absence of lithiasis or inflammation; ••Presence of lithiasis or inflammation; CBD, common bile duct
were performed as a result of diagnostic uncertainties instead of
clear surgical indications.
The optimal timing of surgical interventions depends on the
pathological characteristics of the infected necrotic tissue. Accord-
ing to the guidelines of the International Association of Pancrea-
tology (IAP),2 intervention should be carried out no earlier than 2
weeks after admission, which allows time for the demarcation of
the necrotic areas of the pancreas. The later the surgery is per-
formed, the easier and more complete the necrosectomy is.15–20
Early surgery is indicated only in the very small group of
patients with MOF who do not respond to intensive care treat-
ment2 or who have severe compartment syndrome.4 However,
there is still no consensus on the timing of surgical intervention,
as demonstrated by a recent European survey. In fact, of the
members of the International Hepato-Pancreato-Biliary Associa-
tion (IHPBA) (i.e. clinicians with a declared interest in AP man-
agement), 43% stated that they prefer to perform an intervention
within the first 14 days and only 29% choose to wait 21 days.21
In this series, a nutritional jejunostomy was placed during
surgery in only 11 patients (37.9%); this low number indicates
indifference on the part of Italian surgeons to enteral feeding.
In mild biliary pancreatitis, the aim of surgery is to prevent
recurrence, as stated by international guidelines1–4 and confirmed
by many studies.22–25 In this setting, a cholecystectomy should be
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601
593 patients
212 patients
Cholecystectomy
40 patients 11 patients
Open Open cholecystectomy
cholecystectomy +
CBD stone extraction
performed as soon as the patient has recovered from the pancre-
atitis and preferably during the same hospital admission. In this
series, patients were analysed with biliary pancreatitis without any
other associated aetiological factor (i.e. alcohol consumption
or hypertrigliceridaemia) that might interfere with treatment
options. Nevertheless, only 35.7% of all patients with biliary pan-
creatitis and in situ abnormal gallbladder findings underwent
cholecystectomy (212/593). How can this lack of compliance with
published guidelines be explained?
Some patients may have been unfit for surgery and may have
been treated by sphincterotomy alone.26 Others may have been
discharged from medical departments and submitted to delayed
surgery. Even if a high rate of drop-out is considered, these reasons
do not fully explain the high rate (>60%) of patients who did not
undergo surgery. The vast majority of cholecystectomies (76%)
were performed using a laparoscopic approach; any recent inflam-
matory process caused by mild pancreatitis does not contraindi-
cate a minimally invasive intervention.27,28
The current management of patients with gallstone disease
and choledocolithiasis consists of endoscopic stone extraction
followed by laparoscopic cholecystectomy.2,29 In this series, this
approach was preferred because local experience in laparoscopic
clearance of common bile duct (CBD) stones was poor in most of
the centres participating in the study.
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More than 20% of the cholecystectomies were performed
during a second hospital admission, with a delay of 31 days. This
fact, together with the overall low rate of cholecystectomies, con-
trasts with all published guidelines.1–4 However, this observed dis-
crepancy has been previously reported by Aly et al.,7 Toh et al.30
and Senapati et al.31 in the UK and by Lankisch et al.9 and Foitzik
and Klar8 in Germany, and confirmed by the meta-analysis of
Barnard and Siriwardena.32
In 1999, Uhl et al.33 stated that, after an attack of severe pancre-
atitis, cholecystectomy should be postponed for at least 3 weeks to
limit the risk of infection of pancreatic necrosis. Nealon et al.24
recommended a delayed cholecystectomy in the presence of peri-
pancreatic fluid collection.
In this series, in severe AP cholecystectomy was appropriately
delayed2,34 and the intervention did not seem to affect the course
of illness.
This study demonstrated that some aspects of the surgical treat-
ment of biliary lithiasis in AP outlined in published guidelines have
not been applied in clinical practice in Italy. This may also be true
for European surgery, as suggested by King and Siriwardena.21
Conversely, in 2007, Mofidi et al.35 assessed 759 consecutive
patients admitted to a regional hepatopancreatobiliary surgery
service in Edinburgh covering a population of 1.2 million people
and reported a high level of compliance with guidelines, which the
authors attributed to the reorganization of general surgical services
in Scotland which took place in the 1990s and involved the central-
ization of teams with an interest in the management of pancreatitis.
Connor et al. reported similar results with an audit feedback to
surgeons in a tertiary institution in New Zealand.36 However, in the
current study only a quarter of all patients with mild gallstone
pancreatitis underwent cholecystectomy during their first hospital
admission. Even considering the cholecystectomies performed
during a second hospital stay, with a 31-day delay, the management
goal of adequate treatment was not met in over 60% of patients.
Unlike recently published papers on compliance with guide-
lines, which report results obtained by questionnaire surveys, the
current series does not reflect theoretical treatment patterns (i.e.
what specialists would do rather than what they actually do), but
reports detailed, prospective clinical data. Thus, it gives a very real
picture of clinical practice in Italy.
Although the results of this study call for criticism of non-
compliance with published guidelines, they also show low morbid-
ity and mortality in over 1000 patients, similar to published data.
What lessons can we learn from this multicentre study? The fol-
lowing simple clinical decisions can probably improve outcomes in
pancreatitis. Firstly, patients who are admitted with acute abdomi-
nal pain of uncertain cause should undergo appropriate imaging
techniques (including early CT) with a higher degree of frequency
than is presently the case because, as in this series, the correct
differential diagnosis of severe AP from other acute abdominal
diseases might avoid the need to perform diagnostic laparotomy on
the day of admission. Secondly, in patients operated for severe AP,
a jejunostomy should be more diffusely employed because of the
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proven advantage of enteral feeding over total parenteral nutrition,
and finally, according to international guidelines, patients with
mild biliary pancreatitis should undergo a cholecystectomy during
their initial hospital stay more frequently.
Acknowledgements
The paper is dedicated to Professor Giorgio Cavallini (1940–2009) and Pro-
fessor Lucio Gullo (1938–2009), unforgettable masters of Italian pancreatol-
ogy, latterly at the Universities of Verona and Bologna, respectively.
The authors wish to thank Ennio Sarli for analysis of the data.
This study was supported by an unrestricted grant from Sanofi-Aventis SpA,
Milan, Italy.
Conflicts of interest
None declared.
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Appendix
Members of the ProInf-AISP (Progetto Informatizzato Pancreatite Acuta, Associazione Italiana per lo Studio del Pancreas) Study Group

Agugiaro S, Turri L Ospedale Santa Chiara Trento

Bartoli A, Barberini F, Cavazzoni G Policlinico Monte Luce Perugia
Bartolo F, Della Papa D Ospedale San Luca Vallo della Lucania
Bassi N, Massani M Ospedale Regionale Cà Foncello Treviso
Benedetti A, Macarri G, Piergallini L Ospedale Torrette Ancona
Briani G, Bartolasi L Ospedale di Schio Schio
Bugnano L Ospedale Civile Locri
Buonanno GM, Esposito C Azienda Ospedaliera Moscati Avellino
Cordovana A Ospedale Fatebenefratelli Milan
Cavina E, Seccia M, Lippolis P, Musco B, Barletta M Ospedale Santa Chiara Pisa
Chilovi E, De Guelfi A Ospedale Generale Regionale Bolzano
Chirletti P, Caronna R, Scozzafava S, Cardi M Ospedale Policlinico Umberto I Rome
Cirino E, Buffone A Ospedale Vittorio Emanuele I Catania
Colangelo E, Caracino V Ospedale Civile Pescara

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Cortese F Ospedale S Filippo Neri Rome

Casentini A Ospedale Civile Catanzaro

Costamagna G, Trincali A Policlinico A Gemelli Rome

Curzio M, Clivio S, Segato S Ospedale di Circolo Varese
D'Alessandro A, Ambrosiani V Ospedale San Bortolo Vicenza
D'Ambrosio B, Chiodo C Azienda Ospedaliera Cosenza
Dicillo M, Reale L, Grandolfo A Ospedale San Paolo Bari
Fabbrucci P, Bruscino A, Mugnaini P Ospedale S Maria Annunziata Florence
Ferrarese S, Ugenti I Policlinico Consorziale Bari
Forte GB, Rocco P Ospedale Civile Caserta
Franzè A, Bertelè A, Sereni G Ospedali Riuniti di Parma Parma
Friedman D, Mariani L, Morelli F Ospedale San Martino Genoa
Gai V, Antro C Az Ospedaliera S Giovanni Battista Turin
Garcea D, Gardini A, Lucci E Ospedale GB Morgagni Forlì
Giulianotti PC, Sbrana F, Balestracci T Ospedale della Misericordia Grosseto
Giulini SM, Pellizzari A, Ronconi M, Cimaschi S Ospedale Policlinico Brescia
Grassini M Presidi Ospedalieri Asti
Lacignola S, Calandro L Ospedale Civile Martina Franca
Mazzitelli L, Costarella SM, Egidio A Ospedali Riuniti Reggio Calabria
Mello Teggia P, Stefano E, Cassini P Ospedale San Luigi Gonzaga Orbassano
Modica G, Lupo F, Giraci G Policlinico P Giaccone Palermo
Mosca F, Del Chiaro M Ospedale Cisanello Pisa
Mosella G, Benassai G Policlinico Universitario Federico II Naples
Nanni M, D'Aristotile A Ospedale di Pescara Pescara
Negro P Ospedale Policlinico Umberto I Rome
Pirazzoli A Ospedale degli Infermi Rimini
Rabitti PG Azienda Ospedaliera Cardarelli Naples
Romano C, Gerardi G, Troianello B Ospedale Assalesi Naples
Russello D, Di Stefano A, Avelli S Ospedale Cannizzaro Catania
Salval N, Bellini N Ospedale Generale Regionale Aosta
Scalon P Ospedale Bassano del Grappa Bassano del Grappa
Staudacher C, Parolini D Ospedale San Raffaele Milan
Strazzabosco M, Signorelli S Ospedali Riuniti Bergamo
Tedeschi U Ospedale San Martino Belluno
Testoni PA, Masci E, Mariani A Ospedale San Raffaele Milan
Torelli E, Garcea MR, Lombardi V, Lecconi L Ospedale del Ceppo Pistoia
Valeri L, Presenti L, Alessio F Azienda Ospedaliera Careggi Florence
Ventrucci M, Virzi S, Cipolla A Ospedale di Bentivoglio Bentivoglio

HPB 2010, 12, 597–604 © 2010 International Hepato-Pancreato-Biliary Association