Hepato-pancreato-biliary surgery (HPB surgery), also referred to as hepatobiliary surgery, is a surgical subspecialty of general surgery that is concerned with the surgical treatment of disorders affecting the liver, pancreas and biliary system.
Conditions Conditions treated by HPB surgeons include, but are not limited to: Tumours of the pancreas (adenocarcinoma, pancreatic neuroendocrine tumours, Intraductal papillary mucinous neoplasm (IPMN), etc.) Pancreatic cysts Acute and chronic pancreatitis Gallstones Tumours of the biliary tract (gallbladder cancer and cholangiocarcinoma) Portal hypertension Cholangitis (inflammation of the bile ducts due to ascending bacterial infection of the biliary tree) Tumours of the liver (colorectal liver metastasis, Hepatocellular adenoma, hemangioma, hepatocellular carcinoma) Hepatobiliary and pancreatic trauma
Procedures HPB procedures can be performed through open (traditional laparotomy), laparoscopic or robotic approaches. Regardless of the surgical modality, major HPB procedures carry a high perioperative morbidity and mortality risk. This is due largely to the technical complexity of these procedures and the complicated vasculo-biliary anatomy surgeons must navigate. Common HPB interventions are categorised below according to their primary anatomical location: Biliary tract An endoscopy technique that may be performed by HPB surgeons is endoscopic retrograde cholangiopancreatography. During this procedure, fluoroscopy outlines the biliary tree, facilitating possible interventions such as sphincterotomy and stone extraction. Liver HPB surgeons treat benign and malignant diseases of the liver using advanced surgical procedures. These include liver resections, transplants and ablation therapies — such as microwave ablation, radiofrequency ablation, cryoablation and histotripsy — to destroy tumours. Pancreas Resectional surgery offers the only chance of cure in pancreatic and other periampullary cancers. Pancreatic cancer has a 12% 5-year survival rate; however the American Society of Clinical Oncology estimates that only 20% of pancreatic cancer patients may be eligible for surgery. The primary surgical treatment of pancreatic cancer within the head of the pancreas is a pancreatoduodenectomy, also known as the Whipple procedure.
Notable hepato-pancreato-biliary surgeons Leslie H. Blumgart – one of the most influential figures in the field who sought to make hepato-pancreato-biliary surgery a recognised specialty and developed the Blumgart pancreaticojejunostomy technique. Allen Whipple – namesake of the pancreaticoduodenectomy, described the primary features of insulinomas (Whipple's triad), and revived portocaval anastomosis as a treatment for portal hypertension.
See also
International Hepato-Pancreato-Biliary Association Surgical oncology Abdominal surgery References
External links Toronto Video Atlas of Surgery – Hepato-pancreato-biliary surgery