Hepatobiliary Surgery

The liver, pancreas, gall bladder and bile duct are known as the hepatobiliary and pancreatic system. Surgery to treat cancers and disorders in these organs is highly complicated and challenging and requires a high level of skill and expertise.

The transformation of liver and biliary tract surgery into a full speciality began with the application of functional anatomy to segmental surgery in the 1950's, reinforced by ultrasound and new imaging techniques. The spectrum of gall-stone disease encountered by the hepatobiliary surgeon has changed with the laparoscopic approach to cholecystectomy. There is increased need for conservation techniques to repair the bile duct injuries that arise more often in the laparoscopic approach to cholecystectomy. These and other surgical interventions on the bile ducts should be selected as a function of risk versus benefit in relation to the patient's requirements and the institutional expertise. Bile duct cancers, including hilar cholangiocarcinoma, and gallbladder cancers have a dismal reputation, but evidence is accumulating for better survivals from aggressive approaches performed by specialist hepatobiliary surgeons.

Hepatobiliary and pancreatic surgery can be performed using minimally invasive techniques. Some common procedures include: Removal of the distal (lower) stomach with the Whipple procedure Anti-reflux surgery for the gastrointestinal system Pancreatectomy (partial or total removal of the pancreas) Cholecystectomy (gall bladder removal) Bile duct resection and reconstruction Liver transplant and liver resection (partial or total removal of the liver).

A National Institute of Health symposium held in 2013 that summarized available evidence found a 29% mortality reduction, a 10-year remission rate of type 2 diabetes of 36%, fewer cardiovascular events, and a lower rate of diabetes-related complications in a long-term, non-randomized, matched intervention 15–20 year follow-up study, the Swedish Obese Subjects Study.

The symposium also found similar results from a Utah study using more modern gastric bypass techniques, though the follow-up periods of the Utah studies are only up to seven years. While randomized controlled trials of bariatric surgery exist, they are limited by short follow-up periods.