Treatments

Surgeries

• Major surgeries for benign and malignant conditions of the oesophagus, stomach, intestines, liver and pancreas are carried out routinely.
• Minimally invasive Cholecystectomy, Appendectomy, Splenectomy and Intestinal Resections are also routinely performed.
• Surgery for Hiatus Hernia is another commonly performed procedure.
• The other speciality of the centre is that complex Biliary reconstruction surgery for bile duct strictures is performed on par with any other centre in the world with excellent results.
• Our Minimally Invasive Surgery Division is one of the centers performing the largest number of laparoscopic procedures in the country, performing not only basic laparoscopic procedures but also most of the advanced laparoscopic procedures like laparoscopic esophageal surgery, gastric resections, colorectal surgery, pancreatic surgery and small bowel surgery. We have a state of the art Aida Touchscreen facility, and DVD recording facility and a newer version of the Harmonic Scalpel for bloodless surgery.

Hepatology

With the use of advanced technology and surgical methods, patients now have more options than ever for the treatment of Hepatobiliary disease. for Hepatobiliary surgery offers comprehensive speciality care for diseases of the liver, pancreas and bile duct.

For patients requiring hospitalization, we have a dedicated Hepatobiliary critical care unit, a Hepatobiliary physician on-call, anaesthetists and a specialized O.R. nursing team. At the Liver Center, our focus is on providing experienced, personalized care for all our patients. Our doctors are trained at the world’s most renowned centres in Hepatobiliary surgery and Liver Transplantation and are actively involved in clinical research.

Our team of surgeons, interventional endoscopists, radiologists and hepatologists work together to provide surgical treatment for the following disorders:

Biliary disorders

• Carcinoma of the gallbladder
• Malignant tumors of the bile duct
• Bile duct injuries and strictures
• Choledochal cysts
• Recurrent pyogenic cholangitis

Disorders of the Pancreas

• Pancreatitis
• Pancreatic pseudocyst
• Malignant neoplasms of the pancreas
• Cystic neoplasms of the pancreas
• Pancreatic islet cell tumors

Liver disorders

• Hepatic trauma
• Metastatic neoplasms of the liver (Cancer originated elsewhere & spread to liver)
• Benign (Non-cancerous) tumours and cysts of the liver
• Portal hypertension (portasystemic shunts)

Key Hepatobiliary Procedures

Radiofrequency ablation and chemoembolisation of liver tumours and cancers

Dedicated to providing the highest quality medical and surgical liver care services, Apollo Multispeciality Hospitals, Kolkata offers a broad range of effective treatments for cancer that has shown promising results. Radiofrequency ablation and Chemoembolization are highly successful treatment options available for select patients, whose suitability is recommended after meticulous evaluation by skilled doctors. Radiofrequency ablation sometimes referred to as RFA, is a minimally invasive treatment for cancer. It is an image-guided technique that heats and destroys cancer cells. Imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide a needle electrode into a cancerous tumour. High-frequency electrical currents are then passed through the electrode, creating heat that destroys the abnormal cells. Some common indications for RFA are: 1) hepatocellular carcinoma, which is a primary liver cancer; 2) colon cancer that metastasizes or spreads from the colon to the liver.

Chemoembolization is a combination of local delivery of chemotherapy and a procedure called embolization to treat cancer, most often of the liver. Anti-cancer drugs are injected directly into the blood vessel feeding a cancerous tumour. In addition, synthetic material called an embolic agent is placed inside the blood vessels that supply blood to the tumour, in effect trapping the chemotherapy in the tumour.

RFA and chemoembolization are done at Apollo Multispeciality Hospitals.

Pancreatic Transplantation

A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who usually has diabetes. Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient’s native pancreas is left in place, and the donated pancreas is attached in a different location. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, who have severe complications that are usually of a renal nature. The majority of pancreas transplantations (>90%) are simultaneous pancreas-kidney transplantations. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Pancreatic Transplantation procedure performed at Apollo Multispeciality Hospitals, Kolkata offers a new lease of life to patients with insulin-dependent diabetes and other severe complications, related to kidney function.

Pancreatic Transplantation is done at Apollo Multispeciality Hospitals.

Other Hepatobiliary system surgeries

The most common operation performed on the liver is a resection (removal of a portion of the liver). The most typical indication for liver resection is a malignant tumour. Tumours can be primary (developed in the liver) or metastatic (developed in another organ, then migrated to the liver). The single tumour or more than one tumour confined to either left or right side of the liver can be successfully resected with 5-year survival as high as 60%. Benign tumours of the liver (cyst, adenoma, hemangioma) can be successfully managed by liver resection as well.

Some of the other Hepatobiliary system surgeries are:

• Pancreatic Surgery
• Bile Duct Surgery
• Gall Bladder Surgery
• Portal Hypertension Surgery and Liver Cirrhosis

Minimal access surgery too has a role in Hepatobiliary surgical treatment

Hepatobiliary system surgeries are performed at Apollo Multispeciality Hospitals Kolkata.

Adult Hepatology and Gastroenterology services

The centres also have state of art Hepatology and Gastroenterology services. Endoscopic procedures for the care of liver patients are performed by well qualified and trained gastroenterologists. Complex endoscopic procedures like band ligation for bleeding varices in a cirrhotic, ERCP for a variety of biliary problems, sclerotherapy for control of ulcer bleeding etc are done. We also have capsule endoscopy and liver dialysis system (MARS) under the ambit of Hepatoenterology.

Liver Transplants

Apollo Multispeciality Hospitals’ comprehensive liver transplant care programme aims to provide effective health care by connecting to people dealing with liver disease. The Centers for Liver Diseases and Transplantation, Apollo Multispeciality Hospitals, Kolkata, are equipped with the state-of-the-art technology for liver surgery using the laparoscopic Argon Beam Laser as well as Tissue Link™ in combination with other methods of liver resection like CUSA™ and Laparoscopic Vascular Stapling. Bloodless Liver Surgery is also performed with high success rates.

Who is eligible for liver transplant?

While a liver transplant is the best cure for most patients with non-metastatic liver cancer, the limited organ supply may make this option unviable. The eligibility criteria for transplantation is the presence of a single HCC tumour 5 cm or less in diameter, or fewer tumour nodules, each 3 cm or less in diameter. Both living relative and cadaveric liver transplants are options for patients at the Center for Liver Diseases & Transplantation, Apollo Multispeciality Hospitals, Kolkata. Patients who will obtain maximum benefit from liver transplantation include those who are estimated to have less than one to two years of life and have no alternative medical or surgical therapies. The liver transplant procedure helps prolong the patient’s life for at least five years and/or to restore the patient to a normal or near-normal functional status. Thus, the overall goals of liver transplantation are to prolong life and improve the quality of life.

Pediatric liver transplantation is now an established and successful modality of treatment worldwide for children with acute and chronic end-stage liver disease. The advent of new surgical techniques, immunosuppressive drugs, sophisticated peri and postoperative care has tremendously improved the survival rates in pediatric patients over the last four decades. In the current era, pediatric liver transplant has one and ten-year survival rates of 90 and 80% respectively.

Till a few years back, in the absence of liver transplant facilities in India, a patient with liver failure had only two options, certain death or travel abroad for a transplant. In 1998, India’s first successful pediatric liver transplant was performed in our unit. The recipient is now a healthy teenager. The youngest baby in India was successfully transplanted in August 2008 at the age of 7 months. We have recorded 90% survival rates. Our results are now comparable with the best centers in the West. The surgical expertise gained over the last few years combined with the lessons learnt in medical management have contributed considerably to this achievement.

When is a pediatric liver transplant indicated?

The indications of pediatric liver transplant include biliary atresia, fulminant hepatic failure, chronic liver failure, metabolic disorders like Crigler-Najjar syndrome type I, primary hyperoxaluria type 1, urea cycle disorders and non-resectable hepatic tumors.

For more details visit www.apollolivercare.com

Endoscopy

Endoscopy is routinely performed at the Centers for Medical and Surgical Gastroenterology,Apollo Multispeciality Hospitals,Kolkata for the following conditions:

• For patients who suffer from gastrointestinal bleeding ,both Banding / injection of esophageal varices and control of bleeding with adrenaline injection / argon plasma coagulation are routinely performed.
• For patients with swallowing difficulty due to esophageal stricture or achalasia, endoscopic dilatation can be carried out under fluoroscopic guidance. Similarly, dilatation of pyloric and colonic strictures can also be carried out. In patients with Esophageal tumours, metallic stent placement is done, after dilatation.
• For patients for whom feeding is a problem either due to neurological disorders or altered consciousness levels, endoscopic placement of a nasojejunal tube or PEG (Percutaneous Endoscopic Gastrostomy) tube is done.
• Endoscopic removal of gastric / colonic polyps is routinely done.
• For patients with obstructive jaundice, ERCP / papillotomy / stone extraction from CBD/biliary stenting (plastic as well as metal stents) can be performed.
• Placement of pancreatic stents in patients with severe pain due to chronic calcific pancreatitis is done.
• Esophageal manometry, pH studies and rectal manometry, which are available in only limited centres, are done routinely and help not only in diagnosis but also in deciding which patients with gastroesophageal reflux or achalasia are likely to require surgery.
• Other routine procedures like liver biopsy, aspiration of liver abscess and diagnostic and therapeutic paracentesis are done through endoscopy.

Pancreatic Transplantation

A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who usually has diabetes. Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient’s native pancreas is left in place, and the donated pancreas is attached in a different location. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, who have severe complications that are usually of a renal nature. The majority of pancreas transplantations (>90%) are simultaneous pancreas-kidney transplantations. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Pancreatic Transplantation procedure performed at Apollo Multispeciality Hospitals,Kolkata offers a new lease of life to patients with insulin-dependent diabetes and other severe complications, related to kidney function.

Pancreatic Transplantation is done at Apollo Multispeciality Hospitals,Kolkata.