Hepatobiliary and pancreatic surgery is a relatively new specialty and the vast majority of patients present initially outside tertiary referral centres. Many conditions such as gallstones, acute and chronic pancreatitis, obstructive jaundice and malignancies of the liver, biliary tract and pancreas are still managed outside specialist centres or are not suitable for referral. Many general surgeons continue to manage these problems and in some parts of the world the geography and distances involved makes referral for specialist care difficult or impossible. The relative scarcity of specialist...