Hepatology
Hepatobiliary Surgery
- Our centers of excellence in Hepatology and Hepatobiliary surgery consists of teams of hepatologists and hepatobiliary surgeons addressing all medical and surgical diseases related to the hepatobiliary system. With the use of advanced technology and surgical methods, patients now have more options than ever for the treatment of Hepatobiliary disease.
- Our focus is on providing experienced, personalized care for all our patients. Our doctors are trained at the world’s most renowned centers in Hepatobiliary surgery and Liver Transplantation.
- Our team of surgeons, interventional endoscopists, radiologists and hepatologists work together to provide surgical treatment for the following disorders:
Biliary disorders
The biliary tract includes the liver, gall bladder and bile ducts. They work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. Bile is secreted by the liver into small ducts that join to form the common hepatic duct. Between meals, secreted bile is stored in the gall bladder, where 80%-90% of the water and electrolytes can be absorbed, leaving the bile acids and cholesterol.
During a meal, the smooth muscles in the gallbladder wall contract, leading to the bile being secreted into the duodenum.
Common disorders include:
- Carcinoma of the gallbladder – malignant tumors involving the gall bladder
- Malignant tumors of the bile duct – cancers of the bile duct
- Bile duct injuries and strictures – trauma to the bile duct and post inflammatory narrowing and strictures
- Choledochal cysts – (aka bile duct cyst) are congenital conditions involving cystic dilatation of bile ducts
- Recurrent pyogenic cholangitis – infective disorders of the biliary tract
Disorders of the Pancreas
The pancreas – a spongy, tadpole-shaped organ located behind the stomach — makes enzymes our bodies need to digest food and hormones to regulate blood sugar levels.
Common disorders include:
- Pancreatitis
- Chronic Pancreatitis
- Pancreatic pseudocyst
- Malignant neoplasms of the pancreas – cancers of the pancreas
These make up the vast majority of all pancreatic cancers (around 90%) and come from the cells that line the ducts in the pancreas which carry digestive juices into the intestine. These are called pancreatic ductal adenocarcinomas.
Pancreatic islet cell tumors – These are known as neuroendocrine tumours, and are much less common.
Pancreatic Surgery – pancreatic resections are offered to patients with pancreatic cancers as well as chronic pancreatitis.
Gall Bladder Surgery
The treatment of gallstone disease, both open and laparoscopic gall bladder removal and surgical management of biliary disorders are the common procedures.
Palliative and curative resections for biliary cancer and palliative drainage procedures are performed. Combined liver and bile duct resection for advanced bile duct cancers are being performed regularly. Patients who have inoperable diseases are offered various palliative measures like stenting or bypass procedures.
Biliary reconstruction surgery for bile duct strictures
Repair to healthy bile duct: In the repair, a segment of intestine is brought up to the bile duct and the bile duct is then sutured to the intestine. For long term healing and for good results a normal uninjured bile duct away from the site of the injury should be used. This may be difficult to accomplish in high bile duct injuries. The type of repair performed to the bile duct depends on the level of the injury. For patients who have low injuries to their bile duct finding an area of normal bile duct above the site of the injury and suturing that area to the intestine is easily accomplished for the repair. In patients whose injury is high up in the bile duct close to the liver, the repair is much more complex since finding a segment of normal bile duct above the injury may be extremely difficult.
Portal Hypertension Surgery for Liver Cirrhosis
The goal of portal hypertension treatment is to reduce high blood pressure in the portal vein, the blood vessel that connects the intestines and the liver, and prevent abdominal bleeding. Portal hypertension usually results from various types of cirrhosis (scarring in the liver).
Portal hypertension can cause tiny, thin-walled veins at the base of the esophagus and in the stomach to break and bleed. At this point they are referred to as varices. Physicians usually choose to control varices with medications or endoscopy. Endoscopy involves the insertion of a fiber-optic viewing tube into the gastrointestinal tract. Once the source of variceal bleeding is located, physicians use one of the following endoscopic techniques to control the varices:
- Sclerotherapy, the injection of hardening agents
- Latex banding
- Balloon tamponade
Endoscopic techniques stop bleeding in 90 percent of patients. When medical and endoscopic treatments have failed to control bleeding, portal hypertension surgery may be indicated. The surgery creates an alternate pathway for venous blood flow, called a shunt, to relieve portal hypertension and bleeding varices. The surgical procedure that is most commonly used is called distal splenorenal shunt (DSRS).Alternatively, a minimally invasive treatment called transjugular intrahepatic portosystemic shunt (TIPS) may be appropriate for some patients.
