What is HPB Surgery? A Patient's Guide to Complex Liver, Pancreas, and Bile Duct Operations

HPB (Hepatopancreatobiliary) surgery refers to complex procedures on the liver, pancreas, and biliary system (bile ducts and gallbladder). It is a highly specialized field dedicated to treating both cancerous and non-cancerous conditions affecting these vital organs.

Hello, I’m Dr. Ashish George. Over my years as a specialist in liver, pancreas, and bile duct surgery, I’ve had the privilege of guiding thousands of patients and their families through one of the most challenging times of their lives. I understand that receiving a diagnosis that requires this level of care can be daunting. The medical terms are complex, the path forward seems uncertain, and it’s natural to feel a mix of fear and anxiety.

My goal with this guide is to replace that uncertainty with clarity and confidence. I believe that an informed patient is an empowered patient. By understanding your condition, the team dedicated to your care, and the sophisticated treatments available, you can become an active partner in your own healing journey. This guide is written to be your resource—a straightforward, human-friendly explanation of what HPB surgery is and what you can expect. Here in Delhi, my team and I are committed not just to performing world-class surgery, but to ensuring you feel supported, understood, and hopeful every step of the way.

Understanding Your Body’s “Engine Room”: The HPB System

Before we talk about surgery, let’s briefly cover the organs involved. Think of the liver, pancreas, and biliary system as the central "engine room" of your digestive tract. They work together in a finely tuned partnership to digest food, filter toxins, and manage your body's energy.

The Liver (Hepato-)

Your liver is the largest internal organ and a true powerhouse, performing hundreds of essential tasks. It acts as your body's main filter, cleaning toxins from your blood. It also produces bile, a fluid critical for digestion, and makes proteins that are vital for blood clotting and other functions.

The Pancreas (Pancreato-)

Tucked behind the stomach, the pancreas has two main jobs. First, it produces powerful enzymes that help break down the food you eat. Second, it creates hormones like insulin, which are released into your bloodstream to control your blood sugar levels.

The Biliary System (Biliary)

This is the network of tubes, including the bile ducts and gallbladder, that transports bile from the liver to the small intestine to help digest fats. The gallbladder acts as a storage tank for bile.

Because these three parts are so interconnected, a problem in one can affect the others. This is why treating them requires a specialized, integrated approach known as HPB surgery.

Why You Might Need HPB Surgery: Conditions We Treat

A recommendation for HPB surgery is a decisive step toward treating a specific problem in your liver, pancreas, or biliary system. These operations are used to treat a wide range of conditions, not just cancer. In fact, many of our patients are relieved to learn their condition is benign (non-cancerous) and that surgery can provide a permanent solution to pain or prevent future problems.

Most experts agree that a clear diagnosis is the first step toward a successful treatment plan. Below is a table outlining some of the common conditions that bring patients to our practice for HPB Surgery in Delhi.

Your Care Journey: A Step-by-Step Guide

Facing a major operation can feel overwhelming, but the process is a well-structured pathway. Knowing what to expect can help reduce anxiety and prepare you for each stage.

The First Step: Diagnosis and Creating Your Personalized Plan

Your journey begins with a thorough evaluation. We will review your medical history and perform advanced diagnostic tests to get a precise picture of your condition. These often include:

• Imaging Tests: High-resolution CT scans and MRIs to see the exact size and location of any tumors or abnormalities.
• Endoscopic Ultrasound (EUS): A specialized scope that provides a very close look at the pancreas and bile ducts.
• Blood Tests: To check your organ function and look for specific tumor markers.

Why a Multidisciplinary Team (MDT) is Non-Negotiable for Your Safety

High-quality HPB care is never the work of a single doctor. It is a team sport. Your case will be reviewed by a Multidisciplinary Team (MDT), often in a meeting called a "Tumor Board". This ensures that every aspect of your health is considered by a group of dedicated experts who collaborate to create the safest and most effective treatment plan for you.

Your MDT will include:

• HPB Surgeon (like myself): The leader of your surgical team.
• Oncologist: A doctor who specializes in chemotherapy and radiation, if needed.
• Radiologist: An expert in reading your scans and performing targeted procedures.
• Gastroenterologist/Hepatologist: Specialists in digestive and liver diseases who are often involved in your diagnosis.
• Pathologist: The doctor who examines tissue under a microscope to confirm a diagnosis.
• Specialist Nurses, Dietitians, and Therapists: A support team focused on your education, nutrition, and overall well-being.

Preparing for Success: Prehabilitation and Optimization

In the weeks before your surgery, we focus on getting you into the best possible physical condition. This process, sometimes called "prehabilitation," can significantly improve your recovery. Key steps include:

• Nutrition Optimization: A diet rich in protein is essential for healing. A dietitian may recommend supplements to ensure your body has the strength it needs.
• Stopping Smoking and Alcohol: Quitting at least 2–4 weeks before surgery is critical, as both can impair healing and liver function.
• Gentle Exercise: Simple activities like daily walks and deep-breathing exercises can build strength in your lungs and muscles.
• Managing Other Health Conditions: It's vital to have conditions like diabetes or high blood pressure well-controlled before your operation.

The Day of Your Operation: In the Hands of Experts

HPB operations are complex and typically last several hours under general anesthesia. As your surgeon, I will choose the best approach for your specific situation, always prioritizing your safety and the long-term outcome. The main surgical techniques are:

• Open Surgery: This traditional approach uses a single, larger incision to access the organs directly. It is often necessary for very large or complex tumors.
• Laparoscopic (Minimally Invasive) Surgery: The operation is performed through several small incisions using a tiny camera and specialized instruments. This often leads to less pain and a faster recovery.
• Robotic Surgery: This is the most advanced form of minimally invasive surgery. I control robotic arms from a console, which provides a 3D view and allows for incredible precision and dexterity. This is a technique we specialize in at our center.

A Closer Look at Common HPB Surgeries

Understanding your specific operation can turn fear of the unknown into a clear, concrete plan. While there are many types of HPB procedures, three are among the most common.

The Whipple Procedure (Pancreaticoduodenectomy): Rebuilding Your Digestive System

The Whipple procedure is one of the most complex operations in modern medicine, but for cancers in the head of the pancreas, it is often the only treatment that offers a chance for a cure. While the procedure involves removing several organs—including the head of the pancreas, the gallbladder, the bile duct, and the first part of the small intestine—the true art of the operation is in the reconstruction. I carefully reconnect the remaining pancreas, bile duct, and stomach to the small intestine, restoring the normal flow of digestion.

Liver Resection (Hepatectomy): Harnessing the Liver's Incredible Power to Regenerate

A liver resection is an operation to remove a part of the liver, usually to take out a tumor. What makes this surgery so remarkable is the liver's unique ability to regrow. A healthy liver can regenerate back to its original size within just six to eight weeks after surgery. This amazing biological fact allows us to safely remove up to 75% of a patient's liver, confident that the body will restore what was lost.

Bile Duct Repair and Reconstruction: Restoring a Critical Pathway

This surgery is needed when a bile duct is blocked, narrowed by scar tissue, or injured—sometimes as a complication from a previous gallbladder surgery. The goal is to restore the normal flow of bile. The most common technique is called a Roux-en-Y hepaticojejunostomy, a complex name for a simple concept: we create a new, durable pathway by connecting a loop of the small intestine directly to the healthy bile duct coming from the liver. This bypasses the damaged area and allows bile to flow freely again.

Life After HPB Surgery: The Road to Wellness

Your recovery journey is a partnership between you and our medical team. It requires patience, but a return to a full and active life is the ultimate goal.

A Balanced Perspective: Understanding Risks vs. Life-Saving Benefits

Every major surgery has risks, including infection, bleeding, and blood clots. HPB surgeries have specific risks as well, such as leakage from the new connections we create. My team and I are experts in preventing and managing these complications. It is crucial to weigh these potential risks against the profound benefits. For many cancers, HPB surgery is the only potential cure and can add years of quality life.

This One Post-Surgery Habit Will Transform Your Recovery

If there is one piece of advice I give every patient, it is this: start moving as soon as it is safe. It may seem simple, but getting out of bed and walking, often within 24 to 48 hours of surgery, is the single most powerful thing you can do to speed up your recovery. Walking boosts blood flow, helps prevent pneumonia and blood clots, and "wakes up" your digestive system. It is a cornerstone of modern recovery protocols for a reason—it works.

Your New Normal: A Realistic Recovery Timeline

• First Few Weeks (At Home): This time is for rest and healing. You will focus on managing pain with oral medication, caring for your incision, and eating small, nutritious meals. Daily walks are encouraged, but you must avoid any heavy lifting (anything over 5 kg) for at least six to eight weeks.
• 1-3 Months Post-Op: You will start to feel more like yourself. Your energy will return, and you can gradually increase your activity levels. Most people can return to work around four to eight weeks after surgery, depending on their job.
• Long-Term Wellness: Full recovery can take several months. Long-term health involves regular follow-up appointments, maintaining a healthy diet, and staying active. Some patients, especially after a Whipple procedure, may need to take digestive enzyme supplements with meals.

I have seen patients go on to run marathons, travel the world, and return to the lives they love after these operations. Their stories are a powerful testament to the resilience of the human spirit and the possibilities that modern surgery offers.

Choosing Your Surgeon and Taking the Next Step

Why Experience Matters: Finding the Best Team for HPB Surgery in Delhi

When it comes to complex HPB surgery, where you go for treatment matters. Numerous studies have shown that outcomes are significantly better when these operations are performed at high-volume centers by surgeons with extensive, specialized experience.

My team and I are proud to be a world-class practice specializing exclusively in HPB and liver transplant surgery right here in Delhi. Our commitment to excellence is reflected in our results:

• Deep Experience: We have performed over 1,000 successful HPB surgeries and liver transplants.
• Exceptional Outcomes: Our overall success range for liver transplantation is 92-95%, a testament to our surgical skill and comprehensive care.
• Advanced Technology: We are leaders in using the latest techniques, including robotic HPB surgery, to provide safer procedures and faster recoveries for our patients.
• Patient-Centered Care: From your first consultation to your long-term follow-up, you are the focus of everything we do.

Your Questions Answered & How to Schedule a Consultation

• Do I need a referral?
  While a referral is helpful, you can contact our office directly to schedule a consultation. Our team will guide you.
• What should I bring to my first appointment?
  Please bring all relevant medical records, including imaging reports (CT, MRI), biopsy results, and a list of your medications.
• Will my insurance cover the procedure?
  Our team will work with your insurance provider to verify benefits and help you navigate the financial aspects of your care.

Your journey to healing starts with a conversation. I invite you to schedule a consultation with my team to discuss your condition and create a personalized plan that gives you the best possible chance for a healthy future.

To book an appointment, please call our office or visit our website.