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BACKGROUND: Pancreatic trauma is rare and complex. Non-operative management of pancreatic injuries is often appropriate, and when surgical intervention is required there may be a choice between resectional or more conservative approaches. This is especially true for distal injuries. Operative management of proximal pancreatic injuries is extremely challenging and has less room for conservatism. We sought to characterize the surgical treatment of pancreatic injuries, comparing outcomes for those undergoing formal resection (FR) versus those undergoing more conservative surgical treatment. Our hypothesis was that 'biting the bullet' and resecting is not associated with worse outcomes than less invasive approaches. METHODS: All patients undergoing surgery for pancreatic injuries between June 2001 and June 2019 at the Alfred Hospital in Melbourne were included. Outcome measures including length of stay, return to theatre, total parenteral nutrition use, pancreatic fistula, intra-abdominal infection and mortality were compared between patients undergoing FR and those undergoing non-resectional procedures. RESULTS: Of nearly 60 000 trauma presentations, 194 patients sustained pancreatic injury and 51 underwent surgical intervention. Over 70% were secondary to blunt trauma. There were 27 FR and 22 non-resectional procedures. No major outcome differences were detected. FR was not associated with worse outcomes. CONCLUSION: In distal injuries, where there is doubt regarding parenchymal viability or ductal integrity, FR can safely be performed with non-inferior outcomes to more conservative surgery. Patients with high-grade proximal injuries will usually have multiple other injuries and require resuscitation, temporization and staged reconstruction.

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INTRODUCTION AND BACKGROUND: Three dimensional (3D) printing has gained popularity in the medical field because of increased research in the field of haptic 3D modeling. We review the role of 3D printing with specific reference to liver directed applications. METHODS: A literature search was performed using the scientific databases Medline and PubMed. We performed this in-line with the PRISMA [20] statement. We only included articles in English, available in full text, published about adults, about liver surgery and published between 2005 and 2015. The 3D model of a patient's liver venous vasculature and metastasis was prepared from a CT scan using Osirix software (Pixmeo, Gineva, Switzerland) and printed using our 3D printer (MakerBot Replicator Z18, US). To validate the model, measurements from the inferior vena cava (IVC) were compared between the CT scan and the 3D printed model. RESULTS: A total of six studies were retrieved on 3D printing directly related to a liver application. While stereolithography (STL) remains the gold standard in medical additive manufacturing, Fused Filament Fabrication (FFF), is cheaper and may be more applicable. We found our liver 3D model made by FFF had a 0.1 ± 0.06 mm margin of error (mean ± standard deviation) compared with the CT scans. CONCLUSION: 3D printing in general surgery is yet to be thoroughly exploited. The most relevant feature of interest with regard to liver surgery is the ability to view the 3D dimensional relationship of the various hepatic and portal veins with respect to tumor deposits when planning hepatic resection. Systematic review registration number: researchregistry1348.