Hepatobiliary Surgery

Hepatobiliary Surgery Overview

The hepatobiliary system includes the liver, pancreas, gall bladder and the bile ducts, which work in conjunction to produce and distribute bile. Hepatobiliary surgery describes a wide range of treatments of diseases and conditions involving these organs, including procedures to treat or remove cancers that develop directly within these organs or have metastasized from other areas of the body, most often from the rectum or the colon.

Hepatobiliary surgeons may also evaluate:

Liver abscesses and liver tumors
Liver failure or cirrhosis
Adenoma
Focal nodular hyperplasia
Hemangioma
Cancers of the bile duct system, the gall bladder or the pancreas
Pancreatitis
Stricture (narrowing) or obstruction (blockage) of the bile ducts
Cysts appearing on the liver, pancreas or bile ducts
Polycystic liver disease
Portal hypertension

Wellstar Health System offers a comprehensive range of hepatobiliary treatments, and skilled hepatobiliary surgeons at Wellstar use the most advanced equipment and techniques care for thousands of patients each year.

Procedures

Your team of hepatobiliary specialists will work together to assess your best course of treatment. That will involve the creation of a coordinated plan, evaluating the disease and designing a personalized treatment plan consistent with the highest standards of care. Your treatment will be tailored to your specific type of condition involving the liver, pancreas or bile duct system, and it may involve a combination of surgery, radiation, chemotherapy and, if necessary, transplantation.

Surgical Procedure

Surgery is part of the treatment for many cases involving the hepatobiliary system and varies depending on the location and severity of the affected organs and the health of the patient.

All hepatobiliary surgeries require patients to undergo general anesthesia and follow a strict post-care treatment plan that includes dietary requirements, medication, rest and limited exercise.

The most common biliary surgeries involve treatment for stones, strictures and tumors. Surgery might involve the removal of all or portions of the bile ducts and gall bladder as well as portions of the liver, pancreas or small intestine. These procedures can be completed through an open surgery or through laparoscopy in which a thin, lighted tube is inserted through an incision in the abdomen. For drainage issues, a procedure called a hepaticojejunostomy, can reestablish tracts for bile to flow through.

Surgical treatment options for pancreatic issues include pancreaticoduodenectomy, also known as the Whipple Procedure, in which a surgeon removes the head of the pancreas due to a tumor or pancreatitis. The procedure often requires the removal of the gall bladder, a portion of the small intestine and some of the bile ducts and a re-attachment to the small bowel to allow drainage.

Other pancreatic surgeries include distal pancreatectomy, a procedure (open or laparoscopic) to remove tumors in the body and tail of the pancreas; longitudinal pancreaticojejunostomy (Puestow Procedure), a procedure in which the pancreatic duct is opened from the tail to the head and attached to the small bowel to improve drainage; and distal pancreaticojejunostomy (Du Val Procedure), in which the pancreas is divided across the neck, and both the body and the tail of pancreas are allowed to drain into the small bowel to improve drainage.

Surgical options for the liver include surgical resection to remove tumors, ablation to destroy tumors through radio frequencies or freezing, or with percutaneous ethanol injection therapy (PEIT).

For surgical resection, surgeons can typically remove up to 70% of the liver and expect full regeneration. During this procedure, the surgeon uses an ultrasound to determine the size and scope of the tumor so as little of the liver can be removed as possible. Removal can be made through open surgery or with a laparoscope.

If surgical resection is not an option, surgeons can perform an ablation. For one type of ablation, surgeons can use radio-frequencies to heat up tumors up to 7 cm in size (or up to three lesions of less than 5 cm in size each) to 113° Fahrenheit to destroy them. During cryoablation, argon gas is delivered through probes inserted in the liver. An ice ball is formed around the tumor, which freezes it and then destroys it.

For percutaneous ethanol injection therapy (PEIT), alcohol is injected directly into the tumor to dehydrate the cytoplasm of the tumor and eventually shrink or destroy through the consequent coagulation, necrosis and fibrous reaction.

Medical Oncology & Chemotherapy

Chemotherapy is the use of drugs given by mouth or injection to destroy cancer cells. It can be used to assist in the cure of cancer patients or to prolong life or the quality of life. Adjuvant chemotherapy is administered after surgery in certain circumstances when the patient is at high-risk for recurrence.

Medical oncologists at Wellstar believe in a personalized approach to therapy—often guided by the genetics of the cancer and the condition of the patient.

Radiation Therapy

Radiation or more commonly, CyberKnife^®, can be used to cure some early stage patients who are not candidates for surgery. It is also used concurrently with chemotherapy, and can be effective for controlling symptoms when the cancer has spread to the brain or to bones.

At Wellstar, radiation is administered by radiation oncologists in consultation with medical oncologists and surgeons. And several innovative radiation therapies are offered, including two found to be extremely effective against difficult cases of cancer:

Intensity Modulated Radiation Therapy (IMRT) allows modulation of radiation across the tumor, while sparing healthy surrounding tissue.
The CyberKnife^®, a highly-advanced form of non-invasive radiation therapy that allows treatment of cancer that previously was inoperable or complex. Wellstar was the first health system in Georgia to offer the CyberKnife^®.