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
| 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 has established itself as the centre of choice for patients seeking treatment for complex hepato-pancreatico-biliary diseases along with high-quality patient care. A total of 908 liver transplants have been performed to date for both adults and pediatrics. The program has grown from strength to strength with around a hundred transplants being performed every year for the last several years despite the pandemic. Around 15% of these transplants have been on an emergent basis, which is in itself very rare and unique.
Live donor liver transplant:
The department has an established live donor liver transplant program with results at par with the world's best centres. Complex cases such as variant anatomy, acute liver failure, portal vein thrombosis, ABO incompatible grafts and patients with organ failures are being increasingly performed with good results. We have also started performing ABO- incompatible liver transplants in the acute liver failure setting with good results. There has been no donor mortality in around 800 cases performed by the current team and the major complication rate has been less than 2%. The program has not only benefitted Indian citizens but also helped patients from other countries such as Afghanistan, Pakistan, Nepal, Bhutan, Russia, Uzbekistan, Kazakhstan, Myanmar, and Iraq.
Pediatric liver transplant
The department also has a well-established pediatric liver transplant program. The number of paediatric transplants have gradually increased and now constitute 14% of our total transplants. Of these, 46 were in the setting of acute liver failure. We have performed a total of 129 pediatric liver transplants and have shown good results despite of the complexity involved in the operation and post-operative care. 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 also.
Deceased donor liver transplant
We are currently the largest DDLT centre in north India. Even marginal livers have been used appropriately with good results. The organs have been retrieved from not just within the city but also from other states. The majority of the organs were retrieved from distant cities such as Jaipur, Indore, Lucknow, Patna, and Chandigarh. The department endeavours for the development of Cadaveric organ transplantation in other public sector hospitals and has trained teams from other hospitals to this end.
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.
