HEPATOBILIARY

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.

HEPATOBILIARY - Dr. Pravin Suryawanshi
Infrastructure of HPB Unit MGM Medical College & Hospital, Cidco, Aurangabad

Infrastructure of HPB Unit

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.

Overview

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.

HEPATOBILIARY - Dr. Pravin Suryawanshi

Liver

  • Liver Cirrhosis
  • Hydatid Cyst
  • Liver Trauma
  • Hepatocellular Cancer
  • Metastatic Colorectal Cancer
  • Metastatic Neuro Endocrine Tumors
  • Hepatic Venous Outflow Tract Obstruction Primary Liver Cancer
  • Liver Metastasis
  • Benign Liver Cysts and Tumors
  • Parasitic Cysts Of The Liver (Ecchinococcal Or Hydatid Disease)

Gall bladder

  • Gall stones
  • Calculous Cholecystitis
  • Carcinoma Gall Bladder
HEPATOBILIARY - Dr. Pravin Suryawanshi
HEPATOBILIARY - Dr. Pravin Suryawanshi

Xanthogranulomatous Cholecystitis

  • Bile ducts
  • Biliary Atresia
  • Post Cholecystectomy Bile Duct Injuries
  • Bile Duct Cancers
  • Bile Duct Stones
  • Biliary Stricture
  • Choledochal Cysts
  • Recurrent Pyogenic Cholangitis

Pancreas

  • Acute pancreatitis and its complications
  • Chronic pancreatitis and its complications
  • Pancreatic Cancer
  • Pancreatic Pseudocyst
  • Pancreatic Neuroendocrine Tumors (Nets)
  • Pancreatic Trauma
  • Pancreatic Ascites and Pleural Effusion
  • Cystic Lesions of the Pancreas
  • Intraductal Papillary Mucinous Neoplasm (IPMN)
HEPATOBILIARY - Dr. Pravin Suryawanshi

Services Offered

Pancreas

Gall bladder And Bile Ducts

Liver

Hepatobiliary Surgery Procedures

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 Stent Removal
PEG Insertion
Diagnostic Endoscopic Ultrasound (EUS)
Endoscopic Ultrasound (EUS) with FNAC

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.

HEPATOBILIARY SERVICES (LAPAROSCOPIC)

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. 

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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