Hepatobiliary procedures

Hepatobiliary & Pancrease 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 & pancrease. With the use of advanced technology and surgical methods, patients now have more options than ever for the treatment of Hepatobiliary disease.

For patients requiring hospitalization, we have a dedicated Hepatobiliary critical care unit, a Hepatobiliary physician on-call, anesthetists and a specialized O.R. nursing team. Our focus is on providing experienced, personalized care for all our patients. Our doctors are trained at the India’s most renowned centers in Hepatobiliary surgery.

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 - is a disease in which the pancreas becomes inflamed. Acute pancreatitis is a sudden inflammation and may range from mild discomfort to a severe, life-threatening illness. Chronic pancreatitis is long-lasting inflammation of the pancreas. It most often happens after an episode of acute pancreatitis. Heavy alcohol drinking is another big cause.
• Pancreatic pseudocyst - If the pancreas is injured, its ducts, which carry enzyme-containing juices, can become blocked. This can lead to the development of a fluid-filled sac called a 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.

Liver disorders

• Hepatic trauma - this refers to some form of trauma sustained to the liver. This can occur through either a blunt force such as a car accident, or a penetrating foreign object such as a knife. Liver injuries constitute 5% of all traumas, making it the most common abdominal injury.
• Primary cancers like hepatocellular carcinoma as well as metastatic cancers of the liver (Cancer originated elsewhere & spread to liver)

Benign (Non cancerous) tumors and cysts of the liver.Each cellular component of the liver (e.g., hepatocyte, biliary, endothelial, or other mesenchymal cells) can undergo benign proliferation, but only four lesions have common clinical relevance: hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts.

Portal hypertension this is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal system develops. This increased pressure in the portal vein may lead to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area. Varices can rupture and bleed, resulting in potentially life-threatening complications.

What is endoscopy?

Endoscopy is a nonsurgical procedure performed in order to look into a person's digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, we can view pictures of the digestive tract on a TV monitor.

During an Upper GI Endoscopy, an endoscope is easily passed through the mouth and throat and into the esophagus, allowing the doctor to view the esophagus, stomach, and upper part of the small intestine.

Similarly, endoscopes can be passed into the large intestine (colon) through the rectum to examine this area of the intestine. This procedure is called sigmoidoscopy or colonoscopy depending on how far up the colon is examined. A special form of endoscopy procedure called Endoscopic Retrograde Cholangiopancreatography, or ERCP, allows pictures of the pancreas, gallbladder, and related structures to be taken.

Endoscopic Ultrasound or EUS combines upper endoscopy and ultrasound examination to obtain images and information about various parts of the digestive tract

How Do I Prepare for Endoscopy?

• Gut Preparation - Examining the upper digestive tract (upper endoscopy or ERCP) requires nothing more than fasting for 6-8 hours prior to the procedure. To examine the colon, it must be cleared of stool. Therefore, a purgative is given on the day before the procedure.
• Sedation - For most examinations with an endoscope, sedation is provided. This increases the comfort of the individual undergoing the examination. The sedative, which is administered via an injection into the vein, produces relaxation and light sleep. There are usually few if any recollections of the procedure. Patients wake up within an hour, but the effects of the medicines are more prolonged, so it is not safe to drive until the next day.
• After you are sedated while lying on your left side the flexible video endoscope, the thickness of a small finger, is passed through the mouth into the esophagus, stomach, and duodenum. Most patients experience only minimal discomfort during the test and many sleep throughout the entire procedure. Sedation ensures that you feel no discomfort during the entire procedure.
• If your doctor suspects a cancerous growth, they’ll perform a biopsy during your endoscopy. The results will take a few days. Your doctor will discuss the results with you after they get them back from the laboratory.

What happens after the endoscopy?

After the test you will be observed and monitored by a qualified individual in the endoscopy recovery area until a significant portion of the medication has worn off. Occasionally there could be a mild sore throat, which promptly responds to saline gargles, or a feeling of bloating from the air that was used during the procedure. When fully recovered, the patient will be instructed when to resume their usual diet (probably within a few hours).

GB Multicare Gastroenterology Expertise

The Institute of Gastroenterology at GB Multicare Hospital is dedicated to the management of diseases of the digestive and hepatobiliary systems in children and adults. The Institute offer expert care in both Medical and Surgical Gastroenterology. The Institutes possess modern state of art equipment backed by advanced intensive care units.

Gastroenterology essentially addresses diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. The functioning of the entire digestive system, both related to the passage of food through the digestive canal to the physiological processes of food digestion, absorption and elimination come under the purview of this specialty.

It includes the medical and surgical treatment of diseases such as colon polyps, gastrointestinal cancer, jaundice, cirrhosis of the liver, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), pancreatitis, etc