Hepato-Biliary Pancreatic Surgery

Hepato-biliary and pancreatic surgery typically includes surgical procedures to treat malignant (cancerous) and benign (non-cancerous) conditions that affect the liver, biliary system, and the pancreas as well as other diseases affecting these organs.

Procedures

Surgical treatment options for tumors of the liver include:

• Liver Resection or Removal : Your surgeon will recommend surgical resection only if there is enough healthy tissue left behind for re-growth, after the cancer is removed.

Before surgery, the surgeon maps the region of the tumor with respect to the neighboring structures using ultrasound. The surgery is performed under general anaesthesia. A considerably large cut is made on your upper abdomen to expose the liver, and the blood flow to the liver is blocked in order to reduce bleeding. Then, using a special ultrasonic scalpel the part of your liver that contains cancer is removed. Once the tumor is removed, blood flow to the liver is restored and the incision is closed.

The possible complications following the surgery include bleeding, bile leakage, liver failure, jaundice and deep vein thrombosis (clots in legs). You will probably spend 5 to 7 days in the hospital.

• Ablation : Ablation is a technique that uses high-energy radio waves to destroy liver tumors. Your surgeon will suggest ablation if you are not a good candidate for resection. Liver tumors that are up to 7 cm in diameter are more effectively treated with radiofrequency ablation.

The procedure involves passing an electrode through your skin and into your liver. When the needles are in place, electric current is passed. The current generates heat and thereby destroys the cancerous cells. Each ablation takes about 10 – 30 minutes, multiple ablations may be necessary for a large tumor. Bleeding can be controlled by applying direct pressure and the opening is covered with a dressing. There is no need for stitches.

After the procedure, you may experience pain, mild discomfort or nausea, which can be relieved with medications. The complications of radiofrequency ablation include infection, bleeding, injury to adjacent organs, liver abscess (infection), severe pain, and flu-like symptoms (post-ablation syndrome). Complete recovery will take a few days after which you can continue with your daily activities.

• Liver Transplantation : Your surgeon will suggest transplantation if you have a small tumor (less than 5 cm) or a few tumors (3 or less), and you are not a good candidate for resection. It is a major surgery that involves replacing your liver with a healthy liver from a donor. A small part of the liver can be donated by your relative, or you would be put on a waiting list for a donor. The donated liver is carefully matched to your body.

The surgery is performed under general anaesthesia. A slanting incision is made under your ribs. The blood vessels connected to your liver are cut and the diseased liver is removed. A healthy liver is then put in its place and attached to blood vessels to reestablish the blood flow. The cut is then sutured.

After the surgery, you will be monitored in the ICU, and hospitalized for 7 to 14 days. You will be prescribed antirejection medication to be used lifelong, so that your body accepts the new liver and allows it to function normally. If you experience fever, vomiting and/or diarrhea, increased pain, swelling, redness, bleeding or drainage from the incision site, inform your doctor immediately. The two main complications of this procedure are rejection and infection. You will have follow-up visits with your doctor on a regular basis to monitor how your body has accepted the new liver.

Surgical treatment options for biliary tumors and injuries include:

• Resection : The bile duct and possibly parts of the liver, pancreas, gallbladder and small intestine are removed.
• Biliary Drainage Procedures : These procedures are performed when the bile duct gets blocked, injured or narrowed. A thin drain tube (catheter) is inserted into the bile duct, through which bile drains out into a bag attached outside the body. A stent may be placed to keep the duct open.

Following the procedure, you would be monitored for risks such as infection, bleeding, leakage of bile into the abdominal cavity or around lungs, which may require emergency treatment. If left untreated, these complications can be life threatening.

Biliary Bypass : If the cancer is too advanced to be completely resected, your surgeon may decide to create a bypass to reroute the flow of bile around the tumor.

Surgical treatment options for Pancreas disease include:

• Whipple Procedure : Also known as pancreaticoduodenectomy, it is performed to treat cancers at the head (wide part) of the pancreas. During the procedure, the head of the pancreas, the gallbladder, duodenum, a part of the bile duct, and sometimes a part of the stomach are removed. The remaining bile duct, intestine, and pancreas are then reconnected so that enzymes and bile can flow back into the intestines.

Infection, bleeding, diarrhea, weight loss and diabetes are common surgical complications of this procedure. You will be able to eat small amounts of easily digestible food and may have to take medications to assist digestion.

• Distal Pancreatectomy : It is usually performed when the cancer is found in the middle or tapering end of the pancreas. This procedure takes less time and has a shorter period of recovery when compared to Whipple procedure.
• Total Pancreatectomy : A complete resection is opted when the tumor extends across the pancreas. During the procedure, the entire pancreas, the gallbladder, common bile duct, spleen, and parts of the stomach and small intestine are removed. Following the surgery, the patient loses the ability to create enzymes for digestion and insulin for controlling blood glucose level. Therefore, the patient has to take enzymes and insulin supplements for lifelong.
• Drainage Procedures : It is performed to open the pancreatic ducts that are blocked due to chronic pancreatic damage. An incision is made from your chest to abdomen, and the pancreas is exposed. The pancreatic duct can be opened from head to tail (Puestow procedure) or transversely at the neck and body (Du Val procedure) and connected to a loop of the small intestine, into which the pancreatic juices drain. The incision is then sutured. Complications associated with this procedure include bleeding and pancreatic fistula (due to leakage).
• Pancreas Transplantation : This procedure is primarily indicated for type 1 diabetes. It involves removing your pancreas and replacing it with a healthy pancreas from a donor. The surgery is performed under general anaesthesia. Your surgeon will make an incision in the middle of your abdomen and connect the pancreas and part of the intestine from the donor with your blood vessels. Your pancreas is not removed, but retained to help in digestion. The surgery takes around 3 hours, and is sometimes performed along with kidney transplant, which then takes around 6 hours.

Following the surgery, you will be monitored in the ICU, and hospitalized for about 1 week. You will be prescribed antirejection medication to be used lifelong. The possible complications following the surgery include clots in arteries or veins of the new pancreas, development of cancers after a couple of years, inflammation of pancreas, leakage of fluid from the new pancreas, and rejection.