Hepatopancreatobiliary (HPB) surgery is a highly specialized field dealing with complex conditions of the liver, pancreas, gallbladder, and bile ducts. These procedures are often life-saving and require intricate surgical skill to manage diseases ranging from gallstones and chronic pancreatitis to liver and pancreatic cancers.
HPB surgeries are often categorized by the specific organ being treated and the technique used. Here is a detailed look at the major surgical options available.
Liver Surgeries: Resection, Transplant, and Ablation
The liver’s ability to regenerate makes it uniquely suitable for surgery. Procedures are designed to remove diseased tissue while preserving enough healthy liver to ensure full recovery.
- Resection (Hepatectomy): Removing the Diseased Portion
A hepatectomy is the surgical removal of a portion of the liver affected by tumors, cysts, or trauma.
- Minor Resection: Used to remove small, localized tumors, cysts, or just one or two liver segments.
- Major Resection: Involves removing a larger section, defined as three or more liver segments. Removing the entire right or left half is often called a lobectomy.
- Two-Stage Resection: This approach is necessary for patients with multiple or widespread tumors. The first surgery removes an initial set of tumors, giving the healthy liver time to regenerate and grow larger. A second operation is then performed to remove the remaining tumors.
- Portal Vein Embolization (PVE): A pre-surgical procedure where an interventional radiologist blocks the blood supply to the diseased part of the liver. This forces the blood to nourish the healthy section, causing it to enlarge and prepare for the upcoming major resection.
- Transplantation: A Life-Saving Exchange
Liver transplantation replaces a failing liver with a healthy one.
- Deceased Donor Transplant: The patient receives a whole liver from an organ donor who has recently passed away.
- Living Donor Transplant: A portion of a healthy liver is taken from a living donor and transplanted. Since the liver regenerates, the remaining part in both the donor and recipient will grow back to near-normal size.
- Split Liver Transplantation: A liver from a deceased donor is meticulously divided into two portions (typically a large segment for an adult and a small segment for a child) and transplanted into two separate recipients.
- Ablation: Minimally Invasive Tumor Destruction
Ablation therapies destroy small, localized tumors using energy, often serving as a primary treatment when traditional surgery is too risky.
- Radiofrequency Ablation (RFA): Uses high-energy radio waves delivered through a thin needle to heat and destroy cancer cells.
- Microwave Ablation: Utilizes electromagnetic waves to generate heat, effectively killing tumors.
- Cryoablation: Employs very cold gases to freeze and ultimately destroy the tumor tissue.
Pancreas Surgeries: Complex Resections and Tissue Management
The pancreas performs vital roles in digestion and blood sugar regulation, making its surgery highly complex.
- Resection Procedures
- Whipple Procedure (Pancreaticoduodenectomy): This is the gold-standard, most complex surgery for cancer in the head of the pancreas. It involves removing the head of the pancreas, the duodenum (part of the small intestine), the gallbladder, the bile duct, and often a portion of the stomach. The remaining organs are then carefully reconnected.
- Distal Pancreatectomy: Removes the body and tail of the pancreas, typically for tumors in that region. The spleen is often removed simultaneously.
- Total Pancreatectomy: The entire pancreas is removed, along with associated organs like the gallbladder and spleen. Patients require lifelong insulin replacement therapy (they become diabetic) and enzyme supplements.
- Other Pancreatic Procedures
- Pancreatic Necrosectomy: Surgical removal of dead or infected pancreatic tissue following severe, life-threatening inflammation (necrotizing pancreatitis).
- Auto Islet Transplant: Following a total pancreatectomy, the patient’s own insulin-producing islet cells can be isolated and injected back into the liver. This procedure aims to reduce the severity of post-surgical diabetes.
Gallbladder and Bile Duct Surgeries
These procedures focus on removing the gallbladder or repairing the delicate network of bile ducts.
- Cholecystectomy: The routine surgical removal of the gallbladder, most commonly performed to treat painful gallstones or gallbladder inflammation (cholecystitis).
- Biliary Tract Surgery: A group of procedures performed to address obstructions, strictures, or tumors within the bile ducts, often involving the placement of stents to keep the ducts open.
Biliary Reconstruction: Complex surgery to repair or rebuild bile ducts that have been severely damaged by disease, injury, or previous surgical complications
