Hepatopancreaticobiliary Surgery (HPB)

What is the Hepatopancreatobiliary (HPB) Surgical Unit?

The Hepatopancreatobiliary (HPB) Surgical Unit diagnoses and treats the surgical liver, pancreas, biliary tract, and gallbladder diseases. This unit, one of the main branches of general surgery, consists of general surgeons who specialize in diagnosing and treating benign and malignant diseases of these organs and are experienced in vascular surgery, microsurgery, and surgical oncology.

Although it has yet to be officially recognized as a side branch of general surgery in our country, experts trained in HPB surgery are needed more daily. HPB stands for hepatic, pancreatic, and biliary, Latin names of the liver, pancreas, and biliary tract. Hepatopancreatobiliary diseases are diseases that occur in these organs and the systems with which they are associated. Hepatopancreatobiliary surgery is the name given to surgical interventions used to treat diseases related to these organs. The gallbladder is adjacent to the liver, located in the upper right part of the abdominal cavity, and connected to the liver by bile duct channels.

The biliary tract connects to the duodenum, starting from the liver, first joining with the gallbladder canal and then the pancreatic duct. Diseases in these organs and channels affect the entire digestive system and the bleeding-clotting and excretory systems. Therefore, diseases of these organs are considered undivided.

The importance of hepatopancreatobiliary surgery is increasing. With the development of technology and medicine, alternative methods have started to be used to treat hepatobiliary diseases. Accurate diagnosis of diseases is made with the help of imaging methods. Each patient's unique condition is determined, and its treatment is specially prepared and applied to the person/patient. Because each treatment plan is tailored to the patient, the results obtained also change in a good direction. The fact that the liver and pancreas become organs that can be transplanted has taken the treatment processes to entirely different dimensions.

In this area, diagnosis and treatment are applied to patients with a multidisciplinary approach (multiple medical branches make assessments and treatment decisions). The Medicana Hepatopancreatobiliary (HPB) Surgical Unit works harmoniously with many units. The diagnosis and treatment stages of HPB Surgery-general surgery coordination: anesthesia, infectious diseases, interventional radiology, Gastroenterology-Hepatology, gastrointestinal endoscopy, pathology, medical oncology, microbiology microsurgery and plastic surgery, nuclear medicine, diagnostic radiology, radiation oncology, and intensive care specialists do collaborative work. The excellence in diagnosis and treatment can only be achieved by working harmoniously with all these parts.

Performing liver, biliary tract, gallbladder, pancreatic surgery, and liver transplant under the leadership of specialist Prof. Dr. A. Cem İbiş in the Hepatopancreatobiliary (HPB) Surgery Unit established at Medicana Bahçelievler Hospital, our patients can be ensured that they receive the health care they need by international standards without compromising the principles of accuracy, quality, and reliability.

What diseases Does the hepatopancreatobiliary (HPB) surgical unit deal with?

In the hepatopancreatobiliary surgical unit, diseases that occur in the liver, pancreas, gallbladder, and biliary tract are diagnosed, and an appropriate treatment plan is created. In general, the liver, which can regenerate and heal itself, may sometimes be unable to perform its function due to the underlying disease. In the later stages of the disease, insufficiency of the liver may occur. In this case, the only option may be a liver transplant. Most HPB Surgeons also work in this field by receiving liver transplant training. The most important task of the unit HPB surgery, liver disease (acute or chronic viral hepatitis, benign and malignant tumors, cysts, and liver cancer, etc.) and to provide an accurate and timely diagnosis to each patient in a unique way and to ensure the implementation is selecting the most appropriate treatment method.

Liver tumors can be benign or malignant. The most common benign tumor in the liver is hemangioma. The most common malignant tumor of the liver is hepatocellular cancer (HCC). The most common malignant tumors in the liver are tumors that come to the liver through metastasis(spread) from other organs. In this case, in addition to surgical operations, radiation therapy, chemotherapy, transarterial chemotherapy (TACE), transarterial radiation therapy (TARE), radiofrequency (RF) or microwave ablation methods are also used.

One of the prevalent cystic diseases of the liver in our country is liver hydatid cysts. Liver hydatid cysts occur due to the parasite Echinococcus granulosus, mostly taken with infectious nutrients. A rapidly growing cyst affects its function by pressing on the tissues and organs around it. It can become life-threatening if the cyst ruptures and empties into the abdomen or the biliary tract, leading to obstruction in the biliary tract and severe biliary tract infection (cholangitis). In general, in treating the disease, the drug is used with the Killeen catheter excretion process with the help of Interventional Radiology and one or more surgical methods. Surgical treatment is performed as open or laparoscopic (closed) according to the preference that the surgical team will make according to the condition of the disease.

Gallstones are one of the most common diseases in the gallbladder, separate from the liver but attached to it. This disease is also called colelityase. Gallstones are noticed by chance, mainly because they do not show symptoms. Just because a stone has been detected in the gallbladder does not mean the need for surgery. While it is recommended to apply surgical treatment primarily to patients with symptomatic gallstones, surgical intervention can also be recommended for patients with asymptomatic gallstones in rare cases. "Acute cholecystitis," an acute gallbladder inflammation, is a common hepatobiliary disease.

The most common cause of inflammation in the gallbladder is gallstones (cholecystolityase). In patients diagnosed with acute cholecystitis, which has less than 72 hours between the onset of complaints and admission to the hospital, laparoscopic cholecystectomy (a closed method of gallbladder removal surgery) is recommended under emergency conditions, while in the other group, drug therapy and gallbladder surgery 4-6 weeks after the attack is over is another approach.

Pancreatic cancer, on the other hand, is one of the types of cancer that generally gives late symptoms and, therefore, spreads to the surrounding tissues with a fast course, where there are delays in diagnosis, making surgical treatment difficult and sometimes even impossible. In Whipple surgery (pancreatoduodenectomy) performed in cancers located in the head of the pancreas, the head of the pancreas extrahepatic biliary tract, gallbladder, the entire duodenum, and sometimes a part of the stomach are removed.

In diseases of the liver, pancreas, biliary tract, and gallbladder that require intervention, treatment is performed with open surgery, closed surgery (laparoscopic surgery), and Radiological intervention applications. Other interventional methods can treat abscesses, cysts, and some tumors. Diagnosis and treatment of the following diseases are carried out in MEDICANA HPB disease units:

Liver

• Liver cancer
• Liver tumors (benign and malignant)
• Liver metastases
• Fatty Liver
• Liver cysts
• Liver abscesses
• Viral hepatitis (acute and chronic hepatitis)
• Hydatid of liver cyst
• Liver Cirrhosis
• Liver transplant

Pancreas

• Acute pancreatitis
• Chronic pancreatitis
• Pancreatic cancer
• Pancreatic tumors, cysts (benign and malignant)

Gallbladder and Biliary Tract

• Gallstones (cholelithiasis)
• Inflammation of the gallbladder (cholecystitis)
• Gallbladder tumors
• Biliary tract tumors
• Biliary tract cysts (Choledoc cysts)
• Biliary tract strictures
• Biliary tract injuries (due to cholecystectomy surgery)