Hepatobiliary and pancreatic (HPB) surgeries

Liver tumors removal surgeries, wedge resection, liver segmentectomy, left hepatectomy and right hepatectomy can be done open or laparoscopically. Surgeries are done for benign and malignant tumors of liver and also for solitary metastasis from colorectal cancers.

Carcinoma gallbladderis a very aggressive tumor of gallbladder with poor prognosis, are better managed at comprehensive settings where Medical gastroenterologist, Hepatobiliary surgeon, medical oncologist and radiation oncologists are available.

Cholangiocarcinomas (hilar, intrahepatic, mid CBD and lower CBD tumors) are the tumors which arise from bile ducts. Surgical removal of tumor along with lymph nodes is the best chance of cure. Type of surgery depends on location of tumor.

• Intrahepatic tumors – liver resections
• Hilar tumors – liver resection + hepatico-jejunostomy
• Mid CBD – local resection + LNs resection + hepatico-jejunostomy
• Lower CBD – Whipple’s procedure

Pancreatic cancers – are very aggressive tumors of GI tract with poor survival and also they are diagnosed at late stage on initial presentation. For pancreatic head tumors Whipple’s procedure is required and for pancreatic body and tail tumors distal pancreatectomy with splenectomy will be required. There are other kind of tumors arise from pancreas like cystic neoplasms of pancreas, mucinous tumors, solid pseudopapillary tumors (SPT) and neuroendocrine tumors.

Periampullary tumors is a group of tumors that arise within 2cms of the major papilla of duodenum. Which include lower end cholangiocarcinoma, carcinoma head of pancreas, ampullary tumors and duodenal cancers. Often difficult or impossible to differentiate between each other before resection. These tumors require major surgical procedure called Whipple’s procedure or Pancreatico-duodenectomy, which involves removal of cancer, gallbladder, portion of bile duct, pancreas and small bowel.

Surgery for chronic pancreatitis (CCP) will be required when patient develops recurrent abdominal pain and complications of CCP like pseudocyst, pancreatic ascites and fistula. Commonly done procedures are

• Frey’s procedure (LPJ – Lateral pancreatico-jejunostomy)
• Distal pancreatectomy

Surgical procedures relieve pain and treat complications effectively.

Surgery for acute necrotizing pancreatitis – Infected pancreatic necrosis remains the primary indication for surgery in patients with acute pancreatitis

• Open/lap Necrosectomy
• VARD – Video Assisted Retroperitoneal Debridement

 Pseudocyst drainage procedures – after acute pancreatitis and in few patients of Chronic pancreatitis pancreatic juice gets accumulated outside the pancreas and forms a cyst. Usually pseudocysts are formed around the pancreas. Smaller uncomplicated pseudocysts resolve on their own but few pseudocysts which are large in size and symptomatic ones require treatment. These surgeries can be done Laparoscopically, pseudocysts are drained in to intestines

• Cystojejunostomy – pseudocyst drained to jejunum
• Cystogastrostomy – pseudocyst drained to stomach