ניתוח HPB באינדור

סקירה כללית

Hepato-Pancreato-Biliary surgery is the surgical treatment of diseases of a person’s liver, pancreas, gallbladder and bile ducts. It is used to treat cancerous and non-cancerous diseases of these connected organs. The primary objectives of HPB surgery are to address tumours, infections, blockages and other complications associated with these organs. HPB surgery may be recommended when other treatment methods, such as medication and minor procedures, do not provide relief for the patient. This surgery can be of many types, including transplantation, resection, and reconstruction, among others, performed as either open, laparoscopic, or robotic surgery, depending on the patient’s needs. 

At Apollo Hospitals, Indore, HPB care combines surgical expertise, imaging, endoscopy, and multidisciplinary planning.

HPB surgery refers to specialised surgical treatment for conditions that affect the liver, pancreas, & biliary system. HPB surgery is frequently used to treat disorders such as tumours, strictures, inflammation, and other injuries to these organs. It differs from routine abdominal surgery because the organs are close to major blood vessels and require specialised surgical training. The Department of Gastroenterology at Apollo Hospitals Indore provides HPB surgery and minimally invasive treatment options for the management of complex disorders of the liver, pancreas and bile ducts.

What Conditions Are Treated with HPB Surgery?

Apollo Hospitals Indore is well-equipped to treat and manage multiple conditions requiring HPB surgery across organs. This includes:

מצבי כבד

• Liver tumours
• קרצינומה hepatocellular
• גרורות בכבד
• Selected benign liver conditions
• Liver trauma

מצבי לבלב

• גידולי לבלב
• Selected pancreatic cystic lesions
• Chronic pancreatitis requiring surgery
• סרטן הלבלב

מצבי מרה

• גידולים בצינורות המרה
• Biliary strictures
• פגיעות בצינורות המרה
• Selected gallbladder conditions
• Obstructive jaundice requiring surgical management

When Is HPB Surgery Recommended?

If your condition cannot be effectively treated with medication or other non-surgical procedures, HPB surgery may be recommended. However, keep in mind that not every liver, pancreatic, or biliary condition automatically calls for surgery. That being said, HPB surgery may be required in the case of:

• Resectable liver tumours
• Resectable pancreatic tumours
• גידולים בצינורות המרה
• Complex biliary strictures
• Selected gallbladder and biliary diseases
• Complications requiring surgical intervention
• Selected benign conditions requiring surgery

Symptoms That May Require HPB Evaluation

• כאבי בטן מתמשכים
• צהבת או הצהבה של העיניים
• ירידה בלתי מוסברת במשקל
• אובדן תיאבון
• בחילות או הקאות מתמשכות
• Changes in stool or urine colour
• Recurrent pancreatitis
• נפיחות בבטן
• Unexplained liver or pancreatic abnormalities

Diagnosis Before HPB Surgery

Before HPB surgery is recommended, a thorough evaluation must be done. Diagnostic tests could include:

• בדיקות דם
• בדיקות תפקודי כבד
• הערכת תפקוד הלבלב
• אולטראסאונד
• סריקת סי טי
• MRI/MRCP
• אולטרסאונד אנדוסקופי
• ERCP where indicated
• Biopsy where clinically required
• PET-CT for selected cancers

How Is HPB Surgery Planned?

A patient’s overall health, the complexity of their condition, and surgical anatomy all play important roles in determining the pathway for HPB surgery. In general, the pathway looks like:

1. הערכה קלינית: identification of the problem
2. הדמיה אבחנתית: defining the extent of the medical issue
3. Disease Assessment: assessing if the disease is localised or spread (for cancers)
4. Surgical Candidacy: assessing the patient’s overall health
5. דיון רב-תחומי: discussion between surgeons, oncologists, radiologists, etc. to determine if surgery is the right option.
6. Procedure Selection: selecting the type of surgery depending on various influential factors.
7. כִּירוּרגִיָה: performing the selected surgery.
8. התאוששות ומעקב: patient recovery and future follow-up care.

Types of HPB Surgery

For Liver: Liver resection, partial hepatectomy, tumour resection with a margin of healthy tissue and selected complex liver surgery with major vascular reconstruction.

For Pancreas: Whipple procedure (pancreaticoduodenectomy) - removal of the head of the pancreas together with part of the stomach, duodenum and bile duct; distal pancreatectomy (removal of the tail and/or body of the pancreas, sometimes with the spleen); other resections depending on tumour location

For Biliary: Surgery of the bile duct to remove diseased segments, biliary reconstruction (re-joining the bile duct to the intestine to re-establish drainage) and surgery for selected tumours or strictures not manageable endoscopically.

Minimally Invasive & Robotic HPB Surgery

Laparoscopy and robotics allow surgeons to make smaller incisions than during open surgery. Some of the benefits of minimally invasive surgical procedures include less postoperative pain, smaller scars, and faster recovery.

They are not suitable for every case. Suitability depends on the size and location of the tumour, its proximity to major blood vessels and the complexity of the disease. Some patients with extensive or anatomically challenging disease will still need open surgery. 

Open vs Minimally Invasive HPB Surgery

Whether you are to have open or minimally invasive surgery will be decided by your surgeon based on the complexity of your disease, anatomy, and other factors. 

HPB Cancer Surgery

Includes liver cancer, bile duct cancer, pancreatic cancer, liver metastases, and select gallbladder malignancies. Treatment planning includes staging, assessing resectability (whether the tumour can be safely and completely removed), and coordinating with medical and radiation oncology as needed.

Apollo Indore’s Gastroenterology department offers multidisciplinary management of pancreato-biliary and colorectal cancers, with surgical, medical, and radiological perspectives to plan cancer treatment.

Surgery vs Non-Surgical Treatment

Not every HPB condition requires surgery. Medicines can be used for infections or inflammation; endoscopic procedures (ERCP) to remove stones or place stents; interventional radiology to drain collections or abscesses; and oncology treatment, such as chemotherapy, for cancers that cannot be cut out. Monitoring and periodic imaging can also be done for slow-growing or low-risk findings. The correct approach depends on diagnosis, severity, disease stage and patient factors.

יתרונות וסיכונים 

היתרונות כוללים:

• Removal of diseased tissue or tumours
• Relief of obstruction in selected conditions
• טיפול בסיבוכים
• Potentially curative treatment for selected cancers
• Improved disease control
• Restoration of anatomy/function where appropriate

Potential risks depend on the specific procedure you’re undergoing and your health. They may include:

• מדמם
• זיהום
• דליפת מרה
• Pancreatic leak/fistula
• קרישי דם
• Digestive complications
• Liver-related complications
• אי ספיקה בלבלב
• סיבוכים הקשורים להרדמה

Risks of Delaying HPB Treatment

It is important to be evaluated by a specialist promptly, especially if there is suspicion of cancer or obstructions that can affect bodily function. Delaying HPB treatment can lead to:

• התקדמות מחלות
• Worsening obstruction
• Recurrent complications
• Nutritional deterioration
• Progression of malignancy where applicable

Preparing for HPB Surgery

Preparing for HPB surgery generally includes consultation, imaging, diagnostic evaluation, blood tests, anaesthesia assessment, medication review, nutritional assessment, smoking/alcohol guidance, and various pre-operative instructions given by your healthcare provider.

Recovery After HPB Surgery

Recovery largely depends on the type of HPB procedure you have had. The recovery period typically includes:

• ניטור לאחר הניתוח
• ניהול כאב
• תזונה
• Gradual mobilisation
• טיפול בפצע
• פגישות מעקב
• חזרה לפעילויות היומיומיות
• Additional treatment where required

Nutrition After HPB Surgery

Patients are instructed to eat slowly, starting with liquids and then solid foods. Often the focus is on sufficient protein and calories to support healing. It is important to stay hydrated. Some pancreatic surgeries may call for dietary modifications, including smaller, more frequent meals. If the surgery has had a big impact on a person's digestion, it may be best to consult a dietitian.

Signs That Require Medical Attention After HPB Surgery

If you notice any of the following warning signs after an HPB procedure, reach out to your healthcare provider for further examination:

• קדחת מתמשכת
• הגברת כאבי בטן
• צַהֶבֶת
• הקאות מתמשכות
• דימום מוגזם
• פצע מזוהם
• קושי באכילה או שתייה
• נפיחות בבטן
• Changes in bowel movements accompanied by concerning symptoms

Questions to Ask Your HPB Surgeon Before Surgery

Before going into surgery, make sure you are well-informed. Start by asking your surgeon questions like:

• What condition requires HPB surgery?
• Is surgery the best treatment option for me?
• What type of HPB procedure do I need?
• Can minimally invasive or robotic surgery be considered?
• Will I need open surgery?
• מהם הסיכונים?
• כמה זמן ייקח ההחלמה?
• Will I need additional cancer treatment?
• What dietary changes may be required?
• איזה טיפול המשך אצטרך?

Long-Term Follow-Up After HPB Surgery

Long-term care includes frequent follow-ups to evaluate healing and screening for possible delayed complications, periodic imaging to screen for recurrence and residual disease where necessary, blood tests to evaluate the function of the liver or pancreas, cancer screening for patients who have been operated on because of cancer and also nutritional evaluation where HPB operations affect digestion long term.

HPB Surgeon at Apollo Hospitals Indore

Dr Sudesh Sharda, Liver Transplant Surgeon and HPB Specialist at Apollo Hospitals Indore, is an expert in complex HPB surgery, minimally invasive and robotic HPB surgery, liver tumour surgery, pancreatic surgery and biliary surgery. This combination of expertise allows patients to be assessed for both HPB surgical treatment and, where appropriate, liver transplant evaluation within the same specialist pathway.

למה לבחור בבתי החולים אפולו אינדור?

The Department of Gastroenterology at Apollo Indore offers comprehensive liver, pancreas and biliary care with surgical, diagnostic and endoscopic expertise. Our patients receive:

• Specialised HPB surgical expertise: Surgeons with focused experience in HPB procedures.
• Liver, pancreas and biliary disease management: Comprehensive care for multiple organ conditions, including benign disorders and cancers.
• Minimally invasive HPB surgery: Minimally invasive surgical procedures when indicated, i.e., quicker recovery and fewer complications.
• Robotic HPB surgery: When applicable, it can provide greater precision in challenging cases.
• אמצעי אבחון מתקדמים: Advanced imaging for accurate diagnosis to help plan treatment accordingly.
• Endoscopic interventions: Diagnostic and therapeutic procedures such as ERCP for diseases of the biliary system and pancreas.
• טיפול רב-תחומי בסרטן: Surgical, medical and diagnostic expertise in the management of cancers.
• הערכת השתלת כבד: In-house assessment for patients being considered for liver transplantation.
• Post-operative and long-term follow-up: Postoperative care and long-term follow-up to monitor the patient’s complete recovery.