Pancreas / Hepatobilary

Accurate diagnosis is essential and the procedures require experienced surgeons.

What is Pancreas and Hepatobilary Surgery?

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

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, in 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.

Bile Duct Cancer

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.


Liver Tumors

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.

There are risks associated with removing a liver tumor and testing will help reveal factors that need to be assessed before surgery is pursued. Your surgeon can review your results and recommend the best course of action.

If a partial resection is not possible or complications, such as cirrhosis, have compromised the liver function, a liver transplant may be necessary.


The Whipple Procedure and Pancreatic Resection

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 a procedure used to remove or slow the spread of pancreatic tumors, as well as other disorders of the pancreas, intestine and bile duct. It is a complex operation involving the removal of a portion of the pancreas, the duodenum, the gall bladder and the bile duct. Once the surgeon removes these sections, the surgeon then rejoins healthy sections to restore the digestive tract.

This is a difficult operation that lasts several hours and requires a patient to undergo general anesthesia. This is often performed as an open surgery, laparoscopic surgery, a robotic surgery, or a combination of surgical techniques. It is common for patients to recovery in the ICU for several days following the Whipple procedure. After being released from the hospital, a patient will require continued care and monitoring. Following the Whipple procedure, help at home should be arranged for several weeks.

The Whipple procedure is not appropriate for everyone. Patients will need to go 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.


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