Hepatopancreatobiliary (HPB) surgery: liver, pancreas and bile duct care

The liver makes bile and processes nutrients and medicines, the gallbladder stores bile, the bile ducts carry it to the intestine, and the pancreas produces digestive enzymes and hormones such as insulin. Because these structures lie close together and share blood supply and drainage, problems in one often involve the others.

HPB care is delivered by a multidisciplinary team led by consultant HPB surgeons, together with hepatologists, gastroenterologists who perform endoscopic procedures, interventional and diagnostic radiologists, oncologists, specialist nurses, dietitians and anaesthetists. Complex cancer surgery is usually concentrated in specialist centres that treat higher volumes of patients.

• Gallstones: the NHS says they are common and often silent, but a stone blocking a bile duct can cause biliary colic, with severe, constant tummy pain lasting more than 30 minutes, and sometimes cholecystitis, pancreatitis or jaundice.

• Acute pancreatitis: sudden swelling and inflammation of the pancreas that needs treatment in hospital, commonly caused by gallstones or alcohol.

• Chronic pancreatitis: long-term inflammation and scarring that causes pain, poor absorption of food and sometimes diabetes. The NHS says it has no cure but can be managed.

• Liver tumours: primary liver cancer and cancers that have spread to the liver from elsewhere.

• Pancreatic cancer and bile duct cancer (cholangiocarcinoma): serious cancers that may be symptomless early and are often detected late.

• Benign tumours and cysts of the liver and pancreas, and bile duct injuries or strictures after surgery.

Diagnosis usually starts with blood tests, including liver function tests, and an abdominal ultrasound. CT and MRI scans, including MRCP, which shows the bile ducts in detail, are used to find the cause of jaundice or a mass and to stage cancers. Endoscopic ultrasound examines the pancreas from inside the stomach, and can take a sample. Tumour markers such as CA 19-9 may be used alongside imaging, although they are not used as a screening test.

ERCP combines an endoscope and X-ray to treat stones in the common bile duct. The NHS describes it as passing a long thin camera tube through the mouth into the stomach and widening the opening of the bile duct so stones can pass. It is also used to place stents that relieve blockages caused by tumours.

Cholecystectomy, removing the gallbladder, is usually performed through small cuts using a camera, with open surgery reserved for severe inflammation or when keyhole surgery is not possible. The NHS describes keyhole surgery as the usual approach, and the length of stay depends on the individual and on the operation.

For liver cancer, the NHS says treatment may include surgery to remove part or all of the liver, chemoembolisation, thermal ablation using microwaves or electric current, targeted medicines, immunotherapy and radiotherapy, including selective internal radiation therapy. If the whole liver is removed a liver transplant is needed.

For pancreatic cancer, the NHS says that if it is found early and has not spread, surgery can remove part or occasionally all of the pancreas, often with parts of nearby organs, and recovery can take a long time. Surgery may also be used to relieve blockages and symptoms, and chemotherapy may be given before or after an operation. Bile duct cancer is treated similarly, with surgery removing parts of the bile duct and surrounding structures where possible.

On the NHS, suspected pancreatic, liver or bile duct cancer is handled through urgent suspected cancer pathways from a GP, and the case is discussed at a specialist multidisciplinary meeting before treatment is recommended. Gallstone surgery is typically carried out by general or upper GI surgeons in local hospitals.

Privately, a consultant surgeon, gastroenterologist or hepatologist can arrange imaging and procedures, with major cancer surgery generally taking place in hospitals with intensive care and specialist teams. Costs depend on the operation, theatre time, intensive care, implants and length of stay. Ask whether the surgeon works within a recognised HPB unit and how follow-up and chemotherapy would be arranged.

• Bring all previous scan reports and discs, blood results and a list of medicines, particularly blood thinners and diabetes medicines.

• Ask whether your case will be reviewed by a multidisciplinary team, and who will coordinate your care.

• Ask about the aim of treatment: cure, control of the disease, or relief of symptoms, and what recovery looks like.

• Ask about diet, enzyme replacement and diabetes follow-up after pancreatic surgery.

• Ask for an urgent GP appointment or call NHS 111 if you have pain in your tummy lasting longer than 30 minutes, or yellowing skin or eyes.

• Call 999 or go to A&E for sudden severe tummy pain, pain spreading to the back with vomiting, a very high temperature or feeling hot, cold and shivery with yellow skin.