LIVER DISEASES, LIVER TRANSPLANTATION & HPB SURGERY

Hepato-Pancreato-Biliary (HPB) Surgeries

Liver Resection

Liver resection is the surgical removal of a portion of the liver, usually done to remove various types of liver tumours that are in the liver. The goal of liver resection is to completely remove the tumour and the appropriate surrounding liver tissue without leaving any tumour cells behind. Liver resection is suggested for patients with one or two small (5 cm or less) tumours, confined to the liver with no invasion of the blood vessels.
Resection of a portion of the liver for transplant is referred to as hepatectomy.\When a portion of a normal liver is removed, like in the case of a hepatectomy, the remaining liver will regenerate within a few weeks. A cirrhotic liver, however, cannot regenerate. Hence, before resection is performed for liver cancer, the non-tumour portion of the liver should be biopsied to determine if there is associated cirrhosis.

A liver biopsy is a procedure where a small needle is inserted into the liver to collect a tissue sample. The tissue is analysed in a laboratory to provide doctors with a diagnosis.

Liver Tumour Ablation

Ablation is a treatment that burns liver tumours. It is the preferred option for patients with a few small tumours and when surgery is not a good option due to either poor health or reduced liver function. Ablation is best used for tumours no larger than 3 cm. For slightly larger tumours, it may be used along with embolization. As ablation often destroys some of the normal tissue surrounding the tumour as well, it is not suggested for the treatment of tumours near major blood vessels, the diaphragm or major bile ducts.In this procedure, a needle-like probe is inserted into the tumour through the skin. The probe is guided into place with the help of an ultrasound or CT scan. There are various methods of ablation.

• Radiofrequency ablation: Uses high-energy radio waves to heat the tumour and destroy the cancer cells
• Microwave ablation: Uses the energy from electromagnetic waves to heat and destroy the cancer cells
• Cryoablation: Uses very cold gases to freeze the tumour and cause the cancer cells to die
• Alcohol ablation: Uses concentrated alcohol that is injected directly into the tumour to damage cancer cells

Pancreatectomy

Removal of the pancreas is called pancreatectomy. Based on the location and extent of the cancer spread, one of three surgeries might be suggested by the doctor.

• Total pancreatectomy: This involves the removal of the whole pancreas, part of the stomach and small intestine, common bile duct, gallbladder, spleen and lymph nodes.
• Whipple procedure: Also known as a pancreaticoduodenectomy, this surgery involves the removal of the head of the pancreas, the duodenum (the first part of the small intestine), the gallbladder and the bile duct.
• Distal pancreatectomy: This surgery involves removal of the body and tail of the pancreas. Often, the spleen (an organ that acts as a filter for blood and where old red blood cells are recycled and platelets and white blood cells are stored) is also removed.

Cholecystectomy

The gallbladder is a pear-shaped organ situated below the liver. Its primary function is to store and concentrate bile, a yellow-brown digestive enzyme produced by the liver. Bile helps the digestive process by breaking down fats. At times, small and hard deposits called gallstones can form in the gallbladder. If the gallstones cause health problems, the doctor may suggest removing the gallbladder.

Called a cholecystectomy, during this procedure, the gallbladder is either removed through a 5 to 8 inch long incision in the abdomen or through a less invasive way called laparoscopic cholecystectomy. It is performed through several small incisions rather than through one large incision.

In the first few weeks after surgery, a low-fat diet is generally suggested as it takes the body time to adjust to living without a gallbladder. With time, almost all gallbladder removal-related digestive symptoms go away, however some people might be required to take medication or make lifestyle changes to help manage their symptoms.