| Involves surgery for diseases of the liver, bile duct, gallbladder and pancreas. Treatment of diseases in these parts of the body can be complex and often requires a combination of endoscopic or radiological interventions with surgery. More than ever, the surgeon needs the support of other specialists in medical gastroenterology and radiology to treat patients effectively. Common symptoms from these organs include jaundice, abdominal pain, and back pain, itching and vomiting of blood.
The liver is a large organ that performs a large number of metabolic functions and produces bile. Bile is stored in the gallbladder and released into the bile duct from where it travels to the intestine. Just before entering the intestine, the bile duct is joined by the pancreatic duct carrying digestive juices from the pancreas. The pancreas also produces insulin, a shortage of which may cause diabetes.
Benign or malignant tumors are the commonest cause for operations on the liver. Under special circumstances even tumors that have spread to the liver from other sites are suitable for operation. Up to two-thirds of the normal liver can be removed if necessary. The liver is the only organ in that body that can grow back to its normal size after a portion of it is removed. When tumors are too extensive for resection, other treatments such as Radio-Frequency ablation or Chemo-embolisation may be appropriate. Apart from tumors the liver is sometimes operated upon for Hydatid cysts or complicated cysts.
Cirrhosis of the liver may occur due to a variety of causes, particularly viral infections or alcohol abuse. These patients are prone to develop progressive liver failure or liver cancers that can be treated by replacement of the liver by transplantation.
Venous blood flow leaving the intestines is carried to the liver in the Portal Vein. In certain conditions the blood flow out of the portal vein can be obstructed, forcing blood to find alternate channels of flow. One of the commonest routes blood takes is through veins in the esophagus (varices) that can burst and cause severe bleeding. Although bleeding is effectively stopped by endoscopic means, surgery to divert blood flow and stop bleeding is sometimes necessary.
Gallstones affect a considerable proportion of the population, and when they produce pain or jaundice, operation becomes necessary. The operation to remove the gallbladder is most often performed laparoscopically. Cancers or polyps of the gallbladder are another reason for operations on the gallbladder.
The bile duct may be inadvertently injured during operations to remove the gallbladder. Treatment of this condition, often diagnosed after what was believed to be an uncomplicated operation is difficult and made more so by the complex emotions this diagnosis brings about in both the patient and the surgeon. It is best managed by someone with experience in treating this condition. The bile duct above the level of injury needs to be joined directly to the intestine.
The bile duct can be blocked by stones or tumors. Stones are often treated by endoscopic means but tumors require surgery when the surgeon judges that disease is localized to the bile duct. This is fairly extensive surgery, often requiring removal of a part of the adjacent liver or pancreas.
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