Hepato Pancreato Biliary and Liver Transplant Surgery
The Hepato-Pancreato-Biliary and Liver Transplant Surgery department at ILBS is now considered a centre of excellence. The surgery department in ILBS is the only department in public sector, tertiary care teaching hospital in India, that follows a well-established adult and pediatric liver transplant program. Additionally, it is ahigh volume centre for complex surgeries for both benign and malignant diseases of liver, biliary tract, and pancreas. The department is equipped with state of the art infrastructure and dedicated and skilled professionals. Our results are at par with the best international centre. We attract patients from not only all over the country but internationally as well. We have a very coveted academic program, making our MCh course one of the most sought after in the national entrance examinations. Our department's commitment to good quality research is reflected in our numerous high-impact journals publications.
Services Rendered by the department
Surgery Record from January 2024 to December 2024
| S.No. | Name of Surgery | Unit I | Unit 2 |
|---|---|---|---|
| 1 | Liver Transplant LDLT | 121 x 2 = 242 | 0 |
| 2 | Liver Transplant DDLT | 12 x 2 = 24 | 0 |
| 3 | Whipple’s Procedure | 16 | 13 |
| 4 | Hepatectomy | 21 | 10 |
| 5 | Extended Hepatectomy | 1 | 1 |
| 6 | Exploratory Laparotomy | 15 | 13 |
| 7 | Open Cholecystectomy | 2 | 14 |
| 8 | Lap Cholecystectomy | 114 | 246 |
| 9 | Extended Cholecystectomy | 11 | 8 |
| 10 | Small Intestine Anastomosis/ Cystogastrostomy | 1 | 10 |
| 11 | Non Anatomical Resection | 6 | 1 |
| 12 | Hepaticojejunostomy | 13 | 17 |
| 13 | CDC Excision + RYHJ | 2 | 8 |
| 14 | Distal/ Median Pancreatectomy | 4 | 0 |
| 15 | CBD Exploration | 0 | 3 |
| 16 | Hemicolectomy | 2 | 3 |
| 17 | Lap/ Open Pancreatico-Jejunostomy/ Gastrojejunostomy | 1 | 4 |
| 18 | Cystopericystectomy | 1 | 2 |
| 19 | Incision And Drainage Of Abscess | 1 | 5 |
| 20 | Lymph Node Biopsy/ Staging Lap Biopsy ( Diagnostic ) | 4 | 4 |
| 21 | Tracheostomy | 13 | 1 |
| 22 | Hernia Repair | 22 | 20 |
| 23 | Colostomy/ Ileostomy | 2 | 17 |
| 24 | Proctocolectomy + IPAA | 1 | 1 |
| 25 | Lap/Open Appedicectomy | 1 | 3 |
| 26 | KASAI ( Portoenterostomy ) | 2 | 7 |
| 27 | Lap/Open Hydated Cyst Evacuation | 4 | 6 |
| 28 | Secondary Suturing / Bagota Bag | 7 | 4 |
| 29 | PSRS / Spleenectomy | 1 | |
| 30 | Nephroscopic Necrosectomy | 1 | 5 |
| 31 | Low Anterior Resection | 0 | 2 |
| 32 | Esophagectomy | 1 | 0 |
| Total | 543 | 440 |
| Procedures | 2021 | 2022 | 2023 (till 15th Dec) |
|---|---|---|---|
| Living Donor Liver Transplant | 83 | 89 | 95 |
| Deceased donor liver transplant | 5 | 11 | 6 |
| Major Hepatectomy | 38 | 23 | 32 |
| Minor Hepatectomy | 8 | 26 | 12 |
| Hydatid cyst surgery | 11 | 15 | 9 |
| Choledochal cyst excision | 13 | 14 | 11 |
| Extended Cholecystectomy | 11 | 11 | 15 |
| Hepatico-jejunostomy | 24 | 33 | 27 |
| Kasai Portoenterostomy | 3 | 7 | 12 |
| Pancreatico-duodenectomy | 27 | 32 | 26 |
| Other pancreatic Surgeries | 10 | 8 | 11 |
| Open / Minimal invasive Necrosectomy | 21 | 11 | 4 |
| Proximal splenorenal shunt/Rex | 9 | 9 | 5 |
| Advanced Laparoscopic surgeries | 10 | 15 | 12 |
| Laparoscopic Cholecystectomy | 299 | 254 | 308 |
| Hernia repair | 23 | 43 | 41 |
| Others | 134 | 242 | 47 |
| Emergency surgeries | 59 | 72 | 79 |
| Total No. of surgeries | 791 | 915 | 755 |
New services & facilities added to the department in 2023
- Simultaneous Liver Kidney Transplant
- Swap Live Donor Liver Transplant
- Domino Liver transplant
- ALPPS
Educational Activities
Courses offered by the Department
The department offers a 3-year Medical Council of India approved program in M.Ch. Hepato-Pancreato-Biliary surgery. Six students are enrolled each year by NEET Super-speciality entrance examination.
Department's Achievements (include Departments Research activity as well as Residents achievements
The Department is being increasingly recognized in both patient and medical circles as a destination for high-quality patient care. A total of 1151 liver transplants have been performed till date for both adult and paediatric. The program has grown in strength with around hundred transplants being performed every year for the last five consecutive years with 134 Transplants performed in the year 2024. Around 16% of transplants have been on emergent basis for ALF/ACLF, which is very unique and is a rarity for any program.
Live donor liver transplant:
The department has established live donor transplant program with results comparable to the world's best centres despite operating upon sicker patients. Complex cases such as variant anatomy, portal vein thrombosis and patients with organ failures are being increasingly performed. A departmental protocol for ABO-incompatible transplant have been established with comparable results to other international centres. Live donor liver transplants for acute liver failure are being increasingly performed and the results are steadily improving. We also perform ABO- incompatible liver transplants in the acute liver failure setting with good results. Live donor outcomes have been excellent with no donor mortality in more than 1000 cases performed by the current team with a major complication rate of 2.5%. Although majority of our patients are from India ; because of increasing recognition, many patients from foreign countries such as Bangladesh, Afghanistan, Pakistan, Nepal, Bhutan, Russia, Uzbekistan, Kazakhstan, Myanmar, and Iraq are availing the services.
Pediatric liver transplant
The department has now a well-established liver transplant program for children. The number of paediatric transplants have been increased in the recent times, despite the complexity involved in the operation and post-operative care, we have been managed to deliver good results comparable to best in the world. Paediatric liver transplant is approximately 15 % of our transplant activity which is remarkable. Till date, we have performed 162 paediatric liver transplants out of which one third were for acute liver failure. We have been performing reduced and hyper reduced (mono segment) live donor grafts which have made it possible to perform liver transplant in infants with very low body weight.
Deceased donor liver transplant
We are one of the pioneers of the DDLT program in north India and currently are the largest DDLT centre in north India. Most of the livers though marginal ,were used appropriately with good results. The department has set a new trend of interstate organ transportation in the country. The majority of the organs were retrieved from distant cities such as Bhubaneswar, Kolkata, Jaipur, Indore, Lucknow, Patna, Surat, Rohtak, and Chandigarh. The department is committed to the development of Cadaveric organ transplantation in other public sector hospitals. Towards this endeavour, we have trained teams from other institutes like SMS Jaipur, JIPMER Pondicherry, KGMC Lucknow, IGIMS Patna, AIIMS Jodhpur, AIIMS Bhubaneswar, SGPGI Lucknow, and RML Hospital Delhi. We have started liver transplant program at AIIMS Jodhpur and SMS Jaipur and mentored at SGPGI Lucknow to restart programme successfully, which is a big achievement for the Institute and it will set a precedent for other public sector institutes to start a liver transplant program in the country.
Year wise data of Major Liver Surgeries
| Procedures | 2023 | 2022 | 2021 |
|---|---|---|---|
| Major hepatectomy | 32 | 23 | 38 |
| Minor Hepatectomy | 12 | 14 | 8 |
Hepatocellular Carcinoma
| Procedure Name | Number |
|---|---|
| Right Hepatectomy | 6 |
| Left Hepatectomy | 3 |
| Right extended Hepatectomy | 1 |
| Left extended Hepatectomy | - |
| Left lateral Sectionectomy | 1 |
| Non-Anatomical Resection | 4 |
| Total Number of Liver Resections for HCC | 15 |
Other indications for liver resection
| Diagnosis | Number |
|---|---|
| CA GB | 3 |
| iHCC | 1 |
| Hepatoblastoma | 1 |
| HEHE | 1 |
| Atypical Haemangioma | 1 |
| Hepatolithiasis | 4 |
| Cholangiocarcinoma | 10 |
| Metastatectomy | 4 |
| Complex Cyst | 4 |
| Synovial Sarcoma | 1 |
| Benign Biliary stricture | 1 |
| Total | 31 |
Galbladder Surgeries
| Procedure | Number |
|---|---|
| Extended Cholecystectomy | 15 |
| Right Hepatectomy | 1 |
| Extended right Hepatectomy | 2 |
| Open Cholecystectomy | 11 |
| Procedure | Number |
|---|---|
| Pancreaticoduodenectomy | 26 |
| Open/ Minimal Invasive Necrosectomy | 4 |
| DP + LPJ + Pseudocyst | 11 |
New Procedures
The year 2023 has been a year of 'firsts' where the department of HPB surgery and liver transplant has shown perseverance and commitment to the goal of providing state of the art care. This year also saw completion of 1000 transplants
Simultaneous Liver Kidney Transplant – the first simultaneous liver kidney transplant of ILBS was performed in a 12 year old child with type-I Primary Hyperoxaluria and CKD was performed. With coordinated efforts of the Department of Hepatopancreatobiliary and Liver transplant surgery and the Department of Urology, organs viz. whole liver graft and left kidney were safely retrieved from a 7 year old deceased donor at AIIMS, New Delhi and implanted in the child. The child has been discharged in good health and continues to remain in Follow up.
Swap Live Donor Liver Transplant – In our persistent endeavour to raise the bar we performed the first Swap Live Donor liver transplant in ILBS, wherein two patients underwent live donor liver transplant almost simultaneously with swapping of the living related donors and thus avoiding ABO incompatible transplants in both patients. Both the recipient and donor pairs have been discharged and are recovering well.
Domino Liver transplant – To extend the benefits of liver transplant as many patients as possible, we performed the first Domino Liver Transplant in ILBS. A 37 year old female suffering from amyloidosis underwent a live donor liver transplant. The whole liver retrieved from the woman was transplanted successfully in a 56 year old chronic liver disease patient.
ALPPS – ALPPS is a two stage operation that allows liver resection in patients with a small or marginal liver remnant. We performed our first ALPPS in a 60 year old elderly woman with multifocal hemangioendothelioma and a history of long term methotrexate use for rheumatoid arthritis. The patient is recovering well.
Training of faculty from other institutes and outreach
Department is committed to the development of liver transplantation in other public sector hospitals. This year we trained teams from AIIMS Jodhpur and AIIMS Bhubaneshwar. We have started the liver transplant program at SMS Jaipur successfully, which is a big achievement for the Institute and it will set a precedent for other public sector institutes to start a liver transplant program in the country.
