Gastrointestinal Surgery is an umbrella term for all operations on the gastrointestinal tract. In this age of specialization,it is broadly divided into Upper Gastrointestinal surgery,Colorectal surgery and Hepatobiliary - Pancreatic surgery.
The hepato-biliary and pancreatic (HPB) systems are part of our gastro-intestinal system. It includes the liver, bile duct, gall bladder and pancreas. The HPB 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 effects the other. HPB surgery has therefore emerged as a super-speciality that deals with surgeries of the HPB system.
Bile from the liver is passed into the intestine through the bile ducts. The gall bladder temporarily stores the bile until it is needed for digestion of a large meal, when it is released. Similarly, the pancreas secretes the pancreatic juice into the intestine.
In addition to secreting the digestive juices, these organs serve very important functions to keep our body in a balanced state. The liver regulates acid-base balance, temperature, blood sugar balance, synthesis of proteins and detoxification of chemicals in our body. The pancreas secretes insulin, which is responsible for maintaining blood sugar.
Liver is the largest organ and the largest gland in our body. It is dark reddish brown in color and weighs about 1.2 kg. It is located in the right upper part of abdomen protected by the overlying rib cage. It consists of two main lobes, right and left, each of which have their own blood supply and bile ducts. Each lobe consists of several segments, each of which is a functional unit. Each of these sections have their own set of blood vessels and bile ducts, therefore, if one lobe or segment of the liver is affected by disease, it is possible to surgically remove that lobe, leaving behind the other lobe.
Liver also has the remarkable and unique capacity to regenerate after any surgery or injury, therefore after removing one part of the liver, the remaining liver regenerates and grows in size. Surgeries of the liver are very complex because of its location in the abdomen, which makes it difficult to access. It is also very richly supplied with blood, and therefore the chances of bleeding during surgery are high. Liver surgeries should generally be performed by experienced surgeons at large volume centers only.
More than 500 vital functions have been attributed to the liver, some of the well-known functions are:
- All blood from the stomach, intestines and other abdominal organs goes to the liver, where it is processed.
- Toxic substances such as ammonia are broken down into simpler substances such as urea, in the liver, that can be easily excreted by the body.
- Drugs are broken down into smaller molecules by the liver that are easier to use by the body.
- Molecules such as hemoglobin are processed by the liver, such that their byproducts, such as iron can be re-used by the body for production of red blood cells
- Liver produces proteins from simple molecules called amino acids, that are vital for growth as well as vital functions such as clotting
- Liver produces bile, that helps carry processed toxins out of blood into the intestine and out of the body through stools
- Liver produces cholesterol and some other special proteins that helps absorption and transport of fats in the body
- Liver serves as a storage house of body for energy, where glucose is converted into glycogen (long term storage form of glucose) and supplies it when needed
- Liver produces antibodies, other immune factors and bacteria from the blood to help fight with infections
Bile duct is a tube-like structure that starts in the liver and ends in the intestine. It transports bile from the liver into the part of the intestine called the duodenum. The gall bladder also drains into the bile duct through the cystic duct. The bile duct also joins with the pancreatic duct before opening into the intestine. While the top half of the bile duct is in close proximity of the liver, the bottom half is associated the pancreas. Thus, diseases of the bile duct may also affect the liver and the pancreas.
The gall bladder is a pouch like organ that stores bile secreted by the liver temporarily. It is attached to the undersurface of the liver and has a globular body and narrow neck. It connects to the bile ducts through a small duct called as the cystic duct. Because of such close proximity of the gall bladder to the liver and pancreas, it commonly has to be removed in any surgery of the hepato-pancreato-biliary region.
Pancreas is a fish shaped, yellowish organ situated in the upper part of abdomen, behind the stomach. It is one of the most deep seated organ into the abdomen and is very richly supplied by blood vessels, therefore any surgery on pancreas carries a risk of bleeding. It is in close proximity to major blood vessels of the body and intestinal loops, therefore, diseases involving the pancreas can sometimes involve these structures. The pancreatic juice is secreted via the pancreatic duct into the intestine after it joins the bile duct. The pancreas also secretes important hormones such as insulin, glucagon and somatostatin.
Benign : Liver Hemangioma , Liver Cell Adenoma , Hydatid Cyst
Malignant Conditions : Hepatocellular Carcinoma , Intrahepatic Cholangiocarcinoma.
Operations on the liver :
Laparoscopic Liver cyst excision for Hydatid Cyst
Liver Resections : Anatomical and Non Anatomical resections .
There are a number of ways of treating ulcers but always make sure that treatment is recommended and supervised by your doctor:
Bile duct Stone removal Laparoscopically
Bile duct stricture Operation ( Benign /Malignant ) ,
Iatrogenic Stricture following Open /Laparoscopic Cholecystectomy : Hepaticodochojejunostomy .
Bile duct Tumour Operation
Pancreatitis - Acute and Chronic - Standard of Care treatment with proved results in International Trial conducted by Dr Jignesh Gandhi .
Pancreatic Stones Operations
Pancreatic Resection for Benign and Malignant Conditions
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