Accurate diagnosis is essential and the procedures require experienced surgeons.
The liver, pancreas, gallbladder and bile duct are known as the hepatobiliary and pancreatic system. Surgery to treat cancers and disorders in these organs is highly complicated and challenging and requires a high level of skill and expertise.
Hepato-Pancreato-Biliary surgery, or HPB surgery, is a subspecialty that surgically manages benign and malignant diseases of the liver, pancreas, and biliary tract. The biliary tract (also known as the biliary tree or biliary system) includes the liver, gall bladder, and bile ducts as they work together to produce, store, or deliver bile. Bile performs a critical function in our bodies as it aids in breaking down fat, the removal of bilirubin, the absorption of fat-soluble vitamins, and more.
There are several reasons someone may require HPB surgery, including bile duct cancer, gallbladder cancer, liver cancer, pancreas cancer, pancreatic cysts, pancreatitis, and neuroendocrine tumors. Surgery in this area can be complex and surgeons can use minimally invasive, laparoscopic surgeries to operate on the liver, pancreas, or biliary system. To treat these and other concerns affecting the biliary tract, surgeons perform precise, advanced surgeries such as resections of the liver, pancreas, bile duct, or gall bladder. Bile duct repairs, liver tumor ablation, and the Whipple procedure are also performed to treat HPB-related issues.
The bile ducts in your body are a network of tubes or pipes connecting the gallbladder, pancreas, and liver and transporting bile to the digestive system to process the food we eat. The bile ducts also remove waste from our organs, amongst other essential jobs. However, like other structures in the body, the bile duct can begin to malfunction due to inflammation or obstruction. This can be due to cysts, benign and malignant tumors, and infections such as pancreatitis or cholangitis. Bile duct injuries are often excruciating and can be fatal if left untreated.
Bile duct cancer, known as cholangiocarcinoma, is a rare type of cancer that forms in the bile ducts. The bile ducts are part of the collection of organs and ducts that make and store bile to be released into the small intestine. This includes the liver, gallbladder, and bile ducts found inside and outside the liver. The bile ducts are small tubes responsible for transporting digestive bile from the liver to the gallbladder and to the small intestine. They play an important role and when tumors impact their function it is important to determine if the bile duct tumor is benign or malignant.
Surgery is the primary way to address bile duct cancer. A surgeon relies on imaging and can perform a laparoscopic procedure to closely examine the spread of the cancer.
When a tumor is discovered in the liver, a patient may need to have a partial hepatectomy to remove the liver tumor. A partial hepatectomy is a surgical resection that can be performed as either an open surgery or minimally invasive surgery with similar long-term outcomes. Patients will most likely prefer the immediate benefits of having a minimally invasive laparoscopic surgery, such as having smaller incisions, less blood loss, and often shorter procedure and recovery times. Both an open surgery and a minimally-invasive surgery to remove a liver tumor will require the patient receive general anesthesia and remain in the hospital for one or more days after the surgery.
In 1935, Dr. Allen Whipple performed the first pancreaticoduodenectomy, and it became commonly known as the Whipple procedure. A Whipple procedure, sometimes called a pancreatic resection, is used to remove or slow the spread of pancreatic tumors and other pancreas, intestine, and bile duct disorders. While other therapies such as chemotherapy and radiation can help, surgery offers the greatest likelihood of controlling pancreatic cancer.
The Whipple procedure is not appropriate for everyone. Patients will need to undergo testing and physical examinations to determine if they are good candidates for the procedure. For some, the Whipple procedure is a curative solution while for others it may only slow the spread of a disease. There are many risks involved and your surgeon can review those risks with you.
Distal pancreatectomy refers to removing the removal of the body and tail of the pancreas. The remaining portion of the pancreas is over-sewn or stapled to seal the organ. This allows pancreatic fluid to drain into the small intestine as usual. There are three variations of distal pancreatectomy. The chosen variant depends on the location, type of tumor, and the patient’s physical state.
A central pancreatectomy is most suitable for benign or low-grade tumors in the neck or middle of the pancreas. The remaining pancreatic tissue is split into two parts – the head and the body. The portion of the pancreas closer to the small intestine is sealed, allowing it to drain into the small intestine as usual. The tail of the pancreas, which produces digestive enzymes, is sewn into the back of the stomach or small bowel so that digestion can continue as usual.
A total pancreatectomy combines the Whipple procedure and a distal pancreatectomy, which removes the entire pancreas. As in the Whipple procedure, the first part of the small intestine (duodenum) and the gallbladder are also removed. The spleen is expected to be removed during this procedure as well. After removing the tumor and the organs, the stomach and bile duct are reconnected to the remaining small intestine.
Recovery after pancreatic surgery largely depends on the specific procedure performed and the patient’s general health before surgery – these two factors will influence the ability to recover swiftly. If the procedure was performed laparoscopically, patients will typically have a shorter hospital stay than those who have undergone an open procedure. Average hospital stays will range from three days for a minimally invasive distal pancreatectomyto ten days for a Whipple procedure. Patients should candidly communicate with the clinical staff during their hospital stay to ensure they are comfortable and to make nurses and their surgeon aware of any possible complications.
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Tel: (727) 357-MIIS (6447)
Fax: (727) 356-MIIS (6447)
