Hepatopancreaticobiliary Surgery (HPB)
Hepatopancreatobiliary (HPB) Surgery focuses on education, patient care, and all aspects of the liver, pancreas, and biliary system.
Also, this area is actively involved in the treatment of other GI malignancies, including gastric cancer, gastrointestinal stromal tumors, abdominal soft tissue sarcomas, carcinoid tumors of the GI tract, and peritoneal surface malignancies.
Hepatopancreatobiliary surgeons offer new surgical approaches for people with these diseases, including laparoscopic and robotic pancreatic and liver resection. They are also capable of administering specialized treatments for pancreatic cancer, including ablation and regional perfusion strategies such as hepatic artery infusion chemotherapy.
In addition to removing tumors, repairing or reconstructing damaged or obstructed bile ducts, and, if necessary, performing organ transplants, HPB surgeons are extremely qualified at executing sophisticated surgical procedures. To give their patients the best care possible, they collaborate closely with a multidisciplinary team of specialists, which includes gastroenterologists, radiologists, and oncologists. (1)
Definition and Overview
Hepatopancreatobiliary (HPB) surgery provides access to specialist care and all surgical options and therapies if you have been diagnosed with diseases of the pancreas, liver, gallbladder, or bile duct. HPB surgeons specialize in many procedures and treatments for every stage of the disease, from early to advanced.
Hepatopancreatobiliary (HPB) surgery encompasses a wide variety of surgical procedures associated with disorders affecting the liver, pancreas, and biliary system (including the gallbladder and bile ducts).(2)
These are some examples of the procedures used in HPB surgery. The recommended procedure will vary depending on the patient's diagnosis, stage of the disease, general health, and personalized treatment plan. Depending on the particulars of the patient, each treatment may include modifications and calls for a qualified surgical team. Surgery on the liver, pancreas, and biliary system is referred to as Hepatopancreatobiliary (HPB) surgery. Here are some procedures used frequently in HPB surgery:
- Auto Islet Transplant Surgery
This procedure is used by surgeons to treat chronic pancreatitis, which often calls for a total pancreatectomy. Patients who qualify for auto islet transplant surgery frequently qualify for a procedure that is minimally invasive as well.
- Distal and Total Pancreatectomy
The distal (lower) portion of the pancreas, which normally includes the tail and some of the body of the pancreas, is surgically removed during a distal pancreatectomy. The entire pancreas is surgically removed during a total pancreatectomy.
- Hepatic Artery Infusion Pump
The hepatic artery is connected to this little implanted device. With the pump implanted, doctors can give patients far greater chemotherapy doses that only target liver metastases.
- Minimally Invasive Liver Surgery
Total robotic liver resection and total laparoscopic liver resection are the two minimally invasive liver procedures available to patients. The biology, size, and location of the liver lesions, as well as the patient's qualifications, all influence the sort of liver surgery that is carried out.
- Whipple Procedure
Tumors in the ampulla of Vater, the lower part of the bile duct, and the top of the pancreas are removed during this treatment. The pancreaticoduodenectomy procedure can be carried out either laparoscopically or robotically. (3)
Hepatopancreatobiliary (HPB) surgeons usually employ treatment procedures for patients with certain diseases. These may include, but are not limited to:
- Liver cancer and benign liver tumors
- Pancreatic cancer
- Pancreatic cysts
- Bile duct cancer (cholangiocarcinoma)
- Gallbladder cancer (4)
Risks and Side Effects
Hepatopancreatobiliary (HPV) surgery is a complex and major surgical intervention. Depending on the treatment performed and the patient's health conditions, surgical procedures used to treat illnesses of the liver, pancreas, and biliary system (which includes the gallbladder and bile ducts) may have various risks and side effects. These risks and side effects include:
- catheter-related infection,
- pleural effusion,
- incisional infection,
- pulmonary atelectasis,
- urinary tract infection,
- intraperitoneal hemorrhage,
- gastrointestinal (GIT) bleeding,
- biliary tract hemorrhage,
- coagulation disorders,
- bile leakage,
- liver failure.(5)
Post-Procedure and Follow-up
Patients who undergo HPB surgery typically stay in the hospital for a period to have their recuperation closely monitored. The length of the hospital stay might range from a few days to several weeks, depending on the intricacy of the surgery and the patient's health. The use of oral painkillers rather than intravenous drugs may be considered as the patient's health improves.
Throughout their stay in the hospital, medical staff members monitor a patient's vital signs, the progress of any open wounds, and their overall health. Additionally, they will assess and handle any potential side effects including infection, bleeding, or accumulation of fluid.
The medical staff schedules several follow-up visits to check on the patient's development, assess incision healing, and handle any lingering concerns or questions. When necessary, follow-up visits could also involve diagnostic tests like radiology, blood work, or other types of examinations.
Patients are frequently instructed to gradually get back to their regular activities and daily routines after being released from the hospital. To give the body time to heal, rigorous activity like heavy lifting or intense physical activity should be avoided for a while.
Patients may need to adjust their diets depending on the type of HPB surgery they undergo and the disease they are treating. This can entail a gradual reintroduction to food, beginning with a clear liquid diet and working up to a regular diet in accordance with the advice of the medical staff.
Patients must adhere to the recommendations of their medical team, take prescription drugs as prescribed, show up for follow-up appointments, and report any pertinent symptoms throughout their recovery process. Since each patient's recovery will be different, the healthcare team provides individualized assistance to each patient to promote a successful and quick recovery following HPB surgery.
The general result of HPB surgery is influenced by a number of variables, including the patient's overall health, the stage and severity of the disease, the surgical team's experience, and the existence of any underlying disorders. Prior to the procedure, the healthcare team goes over the expected results, potential risks, and advantages of HPB surgery with the patient in order to promote informed decision-making and reasonable expectations.
1- Duke University School of Medicine. Hepatopancreatobiliary Surgery (https://surgery.duke.edu/divisions/surgical-oncology/sections/hepatopancreatobiliary-surgery)
2,3,4- Johns Hopkins University. Pancreas, Liver, Gallbladder and Bile Duct Surgery at Johns Hopkins Medicine. (https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pancreas-liver-gallbladder-and-bile-duct-surgery-and-surgeons)
5- National Library of Medicine. Indications and Complications of Hepatic Resection Patients at Sher-I-Kashmir Institute of Medical Sciences: An Observational Study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8684362/)