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    Hepatobiliary and Pancreas Surgery
    Surgical Options for Biliary Injuries and Pancreas Disease

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    Overview

    New diagnostic and surgical capabilities have enabled California Pacific's hepatobiliary team to better treat hepatobiliary and pancreas cancer as well as other diseases affecting these organs. Our skilled hepatobiliary team -- comprised of surgeons, interventional endoscopists, radiologists and hepatologists -- works together to provide surgical treatment for the following problems:

    Biliary

    • Carcinoma of the gallbladder

    • Malignant tumors of the bile duct

    • Bile duct injuries and strictures

    • Choledochal cysts

    • Recurrent pyogenic cholangitis
    Pancreas
    • Pancreatitis

    • Pancreatic pseudocyst

    • Malignant neoplasms of the pancreas

    • Cystic neoplasms of the pancreas

    • Pancreatic islet cell tumors
    Liver
    • Hepatic trauma

    • Metastatic neoplasms of the liver

    • Benign tumors and cysts of the liver

    • Portal hypertension (portasystemic shunts)
    With the use of laparoscopy and endoscopic ultrasound (EUS), all patients with malignancies are staged pre-operatively. Following staging, our hepatobiliary team works in conjunction with the referring physician to determine the treatment best suited for the patient's condition. Because choosing a treatment plan is an important decision, we review all options with patients and family members as well as their referring physician, explaining the benefits and disadvantages of each option.

    Biliary Tumors and Injuries

    Biliary surgery is most frequently performed for stones, strictures and tumors. Among the treatment options available at California Pacific include:

    Resection of primary biliary neoplasms (cholangiocarcinoma)
    Roux-en-Y Hepaticojejunostomy Procedure performed for injuries and cancer of the bile duct showing Removed bile duct and gallbladder, Hepaticojejunostomy (Bile ducts drain into small intestine), and Jejunal-Jejunostomy.Treatment of bile duct cancer usually requires removal of the bile duct and possibly portions of the liver, gallbladder, pancreas and small intestine. After resecting the neoplasms -- either through open surgery or laparoscopically -- the surgeon reconnects the bile ducts to the small intestine for proper biliary drainage.

    Biliary Drainage Procedures
    Biliary drainage procedures are performed when the bile duct becomes blocked, narrowed or injured. During surgery, continuity of the biliary tree is usually re-established via a hepaticojejunostomy.

    Surgical Options for Pancreas Disease

    Pancreas sections used in defining tumor(s) location: Head, neck, body & tail. Pancreatic duct runs through all sections.Upon referral of a suspected pancreatic pathology, California Pacific's hepatobiliary team initiates a pre-operative work up which usually includes an evaluation of the pancreas via EUS. This evaluation helps to determine the location of the pathology in the head, neck, body or tail of the pancreas.

    Subsequent treatment options include:

    Pancreaticoduodenectomy (Whipple Procedure)
    Figure 1 showing Pylorus preserved, Cut bile duct, Cut edge of pancreas, Resected pancreas and removed organs, and Jejunum (small intestine)A pancreaticoduodenectomy, also known as a Whipple procedure, involves the removal of the pancreas head due to a tumor in the pancreas or bile duct, or pancreatitis.

    If a tumor exists in the head of the pancreas, it is usually necessary to remove the pancreas head, duodenum, gallbladder and a portion of the bile duct (Figure 1). Sometimes, part of the stomach
    is also removed.



    Figure 2 showing Choledochojejunostomy, Pancreaticojejunostomy, and GastrojejunostomyThe end of a patient's bile duct and the remaining pancreas are then connected to the small bowel (Figure 2) to ensure flow of bile and enzymes into the intestines.







    Distal Pancreatectomy (laparoscopic or open)
    Spleen-preserving Distal Pancreatectomy showing Tumor removed from body of pancreasIndicated for tumors in the body and tail of the pancreas, a distal pancreatectomy involves the removal of cystic neoplasms either laparoscopically or with open surgery. With both laparoscopic and open distal pancreatectomy procedures, surgeons attempt to preserve the spleen.

    Drainage Procedures
    With chronic pancreatitis, a dilated pancreatic duct usually reflects obstruction. Procedures to improve ductal drainage include:

    • Longitudinal Pancreaticojejunostomy (Puestow Procedure): The pancreatic duct is opened from the tail to the head of the pancreas and attached to the small bowel.

    • Distal Pancreaticojejunostomy (Du Val Procedure): The pancreas is divided transversely at the neck, and the body and tail are drained via attachment to the small bowel.

    • Sphincteroplasty: When endoscopic sphincterotomy is unsuccessful, surgical sphincteroplasty may be required of the minor or major papilla.
    Pancreas Transplantation
    A pancreas transplant is indicated for patients with insulin-dependent (Type 1) diabetes.

    Surgical Options for Liver Cancer

    When determining treatment options for tumors of the liver, the hepatobiliary team reviews the results of one's pre-operative evaluation and overall health to recommend appropriate treatment options. Learn more about liver cancer diagnosis and treatment options

    Why Choose Us?

    California Pacific Medical Center offers comprehensive specialty care for diseases of the liver, pancreas and bile duct. We emphasize ongoing communication with referring physicians and incorporate them in the decision process of their patient's medical management. Following treatment, we follow up our care with an organized discharge report to the referring physician.

    For patients requiring hospitalization, we have a dedicated hepatobiliary critical care unit, a hepatobiliary hospitalist, physician assistants, on-call anesthesia staff and a specialized O.R. nursing team. At California Pacific, our focus is on providing experienced, personalized care for all patients.

    California Pacific Medical Center

    California Pacific Medical Center, part of the Sutter Health networkOpens new window, offers specialized care in liver and hepatobiliary and pancreas disease. Our program is based in San Francisco and has outreach locations throughout Northern California and Nevada.

    San Francisco Center for Liver Disease
    California Pacific Medical Center
    2340 Clay Street, 4th Floor
    San Francisco, CA 94115

    Hepatologists
    Tel: 415-600-1020
    Fax: 415-600-1005

    Hepatobiliary Surgeons
    Tel: 415-600–1010
    Fax: 415-600–1012

    For referrals and patient transfer, contact California Pacific’s Specialty Referral Program
    Tel: 1-888-637-2762
    Fax: 1-415-600-2955