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The hepato-biliary and pancreatic systems are part of our gastrointestinal system. It includes the liver, bile duct, gall bladder and pancreas. The Hepato Pancreato Biliary Surgery system secretes digestive juices into the intestine for digestion of ingested food. Diseases affecting the liver, gall bladder, bile ducts and pancreas are often grouped together as these organs are closely related and often abnormality in one of them affects the other.
Liver & pancreas are anatomically located in a very difficult area which makes very difficult to approach them to any surgery. Also, their behaviour is very unpredictable due to ability to secrete active juices.
In addition, the functions of the liver, pancreas, gallbladder and biliary system are so connected; diseases in these areas represent some of the most complex and challenging problems faced by health care professionals today.
These services were available in just few metro cities in India. To provide solutions to these complex & challenging diseases as HPB Surgery, MGM established first dedicated Department of HPB surgery. Since its inception, this department has achieved many milestones like being the ‘First Department to have performed region’s first successful total laparoscopic Whipple’s Liver Transplantation Surgery.’
The pancreas is located in the abdomen, tucked behind the stomach. The pancreas has dual roles; it is an organ of the digestive system and of the endocrine system. The pancreas also produces the hormone insulin, which helps to control the amount of sugar in the blood. Surgery remains the mainstay of treatment for pancreatic ductal adenocarcinoma and complete removal of cancer confers a definite survival advantage, especially in early disease. However, the majority of patients do not present with early disease, thus precluding the chance of a cure by standard pancreatoduodenectomy(PD), distal pancreatectomy or total pancreatectomy.
The department has dedicated HPB theaters used for major HPB Surgery and Liver Transplantation along with all modern surgical equipments. The unit also has state of the art Endoscopy suits including high endoscopes with facility of ERCP (Endoscopic Retrograde Cholangio Pancreatography) and EUS (Endoluminal Ultrasound Scan) for Advanced Therapeutic Endoscopic Intervention.
The whole range of infrastructure required to carry out tertiary Hepato-Pancreato-Biliary surgery (HPB) is available at MGM’s Medical College and Hospital. The Department offers specialized surgical treatment of diseases pertaining to liver, gall bladder, bile ducts and pancreas in both children as well as adults.
Cbd Exploration Laparoscopic
Cbd Exploration Open
Choledochal Cyst Excision Laproscopic
Choledochal Cyst Excision Open
Hepatico Jejunostomy Laproscopic
Hepatico Jejunostomy Open
Intra Op Choledocoscopy
Intra Op Lithotripsy For Cbd Stone
Intraop Cholangiogram
Lap Cholecystectomy Difficult Gb
Lap Cholecystectomy Gangrenous Gb
Lap Cholecystectomy Simple Gb
Lap Cholecystefctomy Empyema Gb
Laparoscopic Liver Abcess Drainage
Laparoscopic Liver Biopsy
Endoscopic Ultrasound (EUS) Guided Celiac Block
Laparotomy With Abdominal Packing In Trauma
Laproscopic Hydatid Cystectomy
Laproscopic Whipple’s
Liver Lobectomy (Right Or Left) Laproscopic
Liver Lobectomy (Right Or Left) Open
Liver Transplant
Laparoscopic Non Segmental Hepatectomy
Open Non Segmental Hepatectomy
Laparoscopic Hepatic Resection
Open Cholecystectomy Difficult Gb
Open Cholecystectomy Empyema Gb
Open Cholecystectomy Gangrenous Gb
Open Cholecystectomy Simple
Open Cysto-Pericystectomy
Laparoscopic Cysto-Pericystectomy
Open Liver Biopsy
Partial Cholecystectomy Laproscopic
Partial Cholecystectomy Open
Radical Cholecystectomy Laparoscopic
Radical Cholecystectomy Open
Triple Bypass
Open Whipples Procedure
Laparoscopic Whipples Procedure
Laproscopic Cholecystodudenostomy
Laproscopic Choledocoduodenostomy
Cystogastrostomy Laparoscopic
Laparoscopic Necrosectomy
Pancreas – Total Excision Of, Or Pancreatico-Duodenectomy
Cystogastrostomy Open
Distal Pancreatectomy Open
Necrosectomy
Pancreas – Total Excision Of, Or Pancreatico-Duodenectomy
Pancreatico Gastrostomy Lap
Pancreatico Gastrostomy Open
Pancreatico Jejunostomy Open
Reversal Of Hartmann’s Procedure Open
The department has firmly set its sights on research activities relevant to its specialty and aims to establish itself at the forefront in its specialty. A healthy blend of clinical and academic activities ensures that every aspect of patient care remains evidence based. Along with its focus on advancements in diagnosis and treatment, the department strives to maintain uncompromising ethical standards. Patient safety is significantly a matter of priority.
Cholecystectomy is the surgical removal of the gallbladder and in some cases the neighbouring ducts. For laparoscopic procedure, several small incisions over the abdominal skin suffice. A scope inserted inside the abdominal cavity allows the surgeon to get a magnified view of the internal organs. The gallbladder is isolated and removed and the neighbouring arteries and veins are sutured. Tissue obtained from the gallbladder may be sent for biopsy if there is suspicion of cancer. Gallbladder inflammation, recurrent gallstone or cancer of gallbladder are the commonest indications of cholecystectomy.
CBD exploration is a surgical procedure aimed at studying the structure of the bile duct to detect the presence of a stone or any other structural abnormality. The surgeon will locate the common bile duct with the help of a small laparoscopic surgical procedure. A dye is injected into the duct which gets circulated through the entire network of ducts that are associated with the gallbladder. X-Ray studies are performed immediately to locate any anomalies in the bile duct. A stent may be kept in place to remove stones if they are detected.
Choledochal cyst is a congenital cyst developing over the duct that transports bile from the liver and gallbladder into the digestive tract (common bile duct). Choledochal cyst excision involves the removal of the cyst along with the common bile duct. The remaining ducts and ductules are used to form a new hepatobiliary network. Hepaticojejunostomy also helps in the treatment of choledochal cysts. Choledochal cyst excision may be done using minimally invasive techniques like laparoscopy or by open surgery.
Hepaticojejunostomy is the creation of a surgical anastomosis between a loop of the jejunum and the hepatic duct. Compression of the hepatic duct due to cysts, tumors of inflammation, hepatic duct stricture are the common indications hepaticojejunostomy. The surgeon ensures an end-to-end connection between the mucosa of the hepatic duct and the jejunum during anastomosis. This prevents leakage of bile from the ducts. The surgeon may perform hepaticojejunostomy using laparoscopic or open surgical methods.
A choledocojejunostomy is a surgical anastomosis between the bile duct and a loop of the jejunum. The procedure is indicated in case of bile duct stricture or compression due to tumors, inflammation or gallstones. The surgeon will access the bile duct using minimally invasive techniques. The site where the bile duct is obstructed is located, and an incision is made along the duct above the level of the obstruction. Another incision is made along the jejunal wall and the sites are anastomosed with one another. The surgery helps to bypass the biliary obstruction and to maintain the structural integrity of the biliary network.
Whipple procedure also known as pancreaticoduodenectomy is a surgical procedure involving removal of the head of the pancreas, the part of the duodenum that connects with the pancreas, the bile duct, and the gallbladder. It is the choice of surgery for the removal of cancerous or benign tumors that are blocking the duodenal lumen or ducts. Laparoscopic pancreaticoduodenectomy involves several small skin incisions over the abdominal skin through which surgical tools and a scope are inserted inside the abdominal cavity. This minimally invasive technique hastens post-surgical recovery with minimal complications.
The pancreas is anatomically composed of three portions i.e, the head, the body, and the tail. Distal pancreatectomy involves surgical excision of the head or tail of the pancreas. Cancer or widespread inflammation of the body or tail of the pancreas are common indications for distal pancreatectomy. The surgeon will make small incisions over the abdominal skin and the abdominal wall to access and remove the pancreas along with any tumor if it is present. The surgeon will explore the head of the pancreas and other neighbouring organs to detect any signs of cancer before concluding the surgery.
Puestow procedure is a technique of creating a surgical anastomosis between the pancreatic duct and a loop of the jejunum. The pancreatic duct is sliced open longitudinally and anastomosed with an opening that the surgeon makes into the jejunal wall. This surgery is an effective form of treatment for the management of pancreatic duct obstruction. Chronic abdominal pain due to pancreatitis also responds well to the Puestow procedure.
Necrosectomy is a generalized term given to the surgical procedure that involves the removal of dead tissue surrounding the healthy internal organs. Inflammation, abscess formation, or tumors developing on the pancreas, liver, or gallbladder may cause necrosis and in some cases gangrene formation. The surgeon used minimally invasive techniques to access the abdominal cavity and remove the necrosed tissue. Due care is taken to avoid damage to the surrounding healthy organs while removing the necrosed tissue and other debris.
Cystogastrostomy is one of the most successful forms of surgical treatment for pancreatic pseudocysts. MRI or CT-guided studies are used to determine the exact number and location of the pseudocysts. An opening is created surgically on the wall of the cyst, and another one is created on the gastric wall. The cyst is allowed to drain into the stomach and left to heal naturally. The contents of the cyst traverse the digestive are expelled out along with other fecal matter.
Hydatid cyst is a fluid filled swelling that forms on the liver as a result of infection from a parasite known as Echinococcus granulosus. Cysto Pericystectomy is a surgical method to remove the cyst and its contents without the need for drainage. The surgeon will explore the liver to locate the number and dimension of the hydatid cysts. The sac of the cyst is removed and its contents are eliminated without rupturing the cyst to avoid spillage in the neighbouring healthy liver tissue. The cysts are often treated with an antiparasitic drug before removing them.
Hepatectomy is the surgical removal of a large percentage of the liver tissue and leaving behind just enough tissue to retain normal hepatic functions. The liver is capable of regenerating its own cells gradually from the healthy cells that get left behind.Â
Cancer of the liver, recurrent cysts, fatty liver cirrhosis, widespread liver inflammation are common indications of hepatectomy. During the surgery, the hepatic blood vessels, the gallbladder and the various ducts connecting with the liver are isolated before removing the unhealthy liver tissue. Hepatic duct is also removed and the remaining ducts are anastomosed to maintain the structural and functional integrity of the hepatobiliary network of ducts. Tissue samples from the excised liver may be sent for biopsy to establish further treatment protocol.
A liver abscess is a pus-filled swelling over the liver caused by the spread of infection from other sites or due to primary infection of the liver itself. For laparoscopic drainage of the abscess, the surgeon will make multiple small surgical incisions over the abdominal skin. A laparoscope is inserted through one incision which allows the surgeon to locate the abscess. The sac of the abscess is carefully excised and all the pus is drained without any spillage. The surgeon will explore the liver and the neighboring organs for any undetected abscess.
Liver biopsy involves obtaining a part of the liver tissue to be sent for pathological examination. The procedure is commonly done to study the liver tissue for detection and staging of cancer. For liver biopsy, the surgeon will insert a scope through a small skin incision to study the structure of the liver. A small part of the diseased liver tissue is carefully removed with due care to avoid spillage into the neighboring healthy tissue. The tissue is sent for pathological examination immediately.
The structure of a liver is anatomically divided into five distinct lobes. Liver disorders like inflammation, cancer, cirrhosis can be treated by the surgical removal of the affected lobe of the liver. The procedure of removal of a single lobe of liver is known as liver lobectomy.
Laparoscopic liver lobectomy involves minimally invasive techniques to access the liver and studying the lobes with the help of a scope. The liver lobe that is to be excised is carefully dissected and separated from its vascular attachments and attachments to the other lobes of the liver. Liver lobectomy is also known as hemi-hepatectomy.
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