Liver Transplant & HPB Surgery
The Liver Transplant and HPB surgery team at Narayana Health is among the most experienced in India. We offer treatment for end-stage liver disease(liver cirrhosis), unresectable liver tumour or metabolic liver disease; meeting the criteria for liver transplant. The team has extensive experience of doing complex hepatobiliary surgery for both benign and malignant diseases using open and laparoscopic approach. We are a reputed liver transplant hospital in India trusted by patients from India and across the world.
Our team was the first to use the robotic surgical platform for doing liver resections in India, our work is published in indexed surgical journals. We have also been actively using this technology (da Vinci surgical system) for doing hepatobiliary cases including choledochal cyst resection with Roux-en-Y hepaticojejunostomy, liver cyst resection, and radical cholecystectomy. The team has experience in treating liver and biliary diseases as enumerated. Our experienced team of liver transplant and HPB surgeons can treat the most complex cases using state-of-the-art equipment at Narayana Health. We strive to provide world-class treatments at affordable prices for patients suffering from liver diseases, cancers, and diseases of the bile duct, gallbladder, and pancreas. This is why we are rated as one of the best liver transplant centers in India.
When Do You Need a Liver Transplant Surgery?
A liver transplant surgery is recommended when the liver gets damaged, and it is beyond the body’s regenerative capacity to repair and heal. It is generally performed when there is liver failure due to tumours, scarring of the tissues within the liver, liver diseases, or general diseases. The reasons for liver transplant surgery vary depending on the age of the patient.
Liver failure may happen quickly or gradually over time. Sudden loss of liver function is called acute liver failure while chronic occurs slowly over months and years. Major causes of damage to the liver may include:
- Hepatitis B and C.
- Alcoholic liver disease
- Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver, causing inflammation or damage to the cells within the liver.
- Genetic diseases also affect the liver including hemochromatosis, which causes an excessive iron buildup in the liver, and Wilson's disease, which causes an excessive copper buildup in the liver.
- Diseases that affect the bile ducts (the tubes that carry bile away from the liver), such as primary biliary cirrhosis, biliary atresia, etc.
Liver Transplant surgery in Children
Children usually need liver transplant surgery due to a condition known as biliary atresia. The bile ducts that transport the bile juice to the gallbladder and the intestine are underdeveloped in children suffering from this condition. The condition can be corrected with reconstructive surgery in the initial few months after birth. But if the problem persists, the child may require a liver transplant surgery.
Another common ailment that needs a liver transplant in children is a tumour known as hepatoblastoma. It is crucial to choose a liver transplant hospital in India with an experienced team of surgeons to conduct liver transplant and HPB surgery for young children.
Liver Transplant Surgery in Adults
There are many reasons that may necessitate liver transplant surgery in adults. Some of them are:
- Hepatitis C virus
- Hepatitis B virus
- Primary Biliary Cirrhosis
- Non-Alcoholic Fatty Liver
- Primary Sclerosing Cholangitis
- Hepatocellular carcinoma
- Hepatitis A or B virus
- Damage caused to drug overdose
- Liver cirrhosis
Liver Transplant & Hepatobiliary Services at Narayana Health
- Orthotopic Liver transplant
Orthotopic liver transplantation involves the surgical removal of a patient’s liver and replacing it with a liver harvested from a deceased donor in the same anatomic position as the original organ. During the transplant surgery, the surgeon creates a small incision on the abdomen to remove the damaged liver and replace it with a healthy liver from a donor. The surgeon positions the donor’s liver in the place of the removed liver and connects all the blood vessels and bile ducts. Once the procedure is completed, the incision is closed. The surgeon attaches drainage tubes to drain away excess fluids and transfers the patient to the ICU for further treatment and recovery
- Living donor Liver transplant
This surgical procedure involves taking a portion of the liver from a healthy living person and placing it into someone with liver failure.
The doctors first operate on the donor to remove a portion of their liver. The surgeons can remove the right or left side of the liver, depending on the age of the patient. The right lobe or right side of the liver is bigger, and hence, it is recommended for adult patients. As the left lobe is smaller, it is suited for children.
The surgeon makes an incision on the abdomen and removes the damaged liver. Later, the right or left lobe from the donor is placed in the position, and all the blood vessels and bile ducts are connected. The incision is closed now and the patient is shifted to the ICU for recovery and treatment.
The donor can regrow the remaining part of their liver, which can return to its normal size, volume, and capacity within a few months after the surgery. The transplanted liver grows and restores its size and function too.
- Split donation Liver transplant
Due to the anatomy of the liver, it can’t be split evenly for transplantation. For the split donation liver transplant, the organ is divided into two parts – 35-40% is the left lobe, and 65-70% is the right lobe. Since the split liver halves are smaller than the whole organ, the surgery can benefit smaller patients who weight between 100 and 160 pounds.
To maximise the benefit of each available donor organ, the two parts of the liver can be transplanted to two different patients. This procedure is generally used if there are two patients who require a liver transplant surgery, (one an adult and the other a child). The process of the surgery is the same as the living donor liver transplant. The transplanted liver grows to the normal size through the process of regeneration.
Auxiliary Liver Transplant
This procedure is preferred for patients with hereditary or metabolic liver diseases. The surgeon removes only the diseased part of the liver, and the remaining liver is left in place for spontaneous recovery or recovery through gene therapy.
In hepatectomy, all or a part of the liver is surgically resected.The procedure is performed to remove tumours from the liver cells called “hepatocytes”. It is used for patients suffering from localized resectable liver cancer, which does not spread to the lymph nodes or other parts of the body. During the hepatectomy procedure, the surgeon can remove a part of the liver that is affected by the tumour, the right or left lobe of the liver or a larger portion depending on the location and size of the tumour.
When only a part of the liver is removed it is known as partial hepatectomy. In this procedure, the doctors’ remove only the diseased part of the liver and leave the healthy liver to regenerate and carry its functions.
- Robot-assisted laparoscopic hepatectomy
Laparoscopic hepatectomy is a modern alternative to hepatectomy. It is a minimally invasive procedure that offers a safe and effective way to treat liver diseases. Laparoscopic surgeries help to shorten the hospital stay, provide a quick return to a normal diet, and offer full mobility in a short span.
The procedure is performed under general anaesthesia. The surgeons make three to seven small incisions on the abdomen, depending on the location of the tumour, its size and the amount of the liver to be removed.
The robot-assisted laparoscopic hepatectomy can overcome the limitations of conventional laparoscopy. It offers increased dexterity and a three-dimensional and magnified view of the operative field.
- Combined liver and bile duct resection
This procedure is performed to remove tumours located high in the bile ducts. The surgeons remove the gallbladder along with the common bile duct. Later, a portion of the small intestine is directly attached to the remaining part of the bile ducts. This process provides a way for the bile to flow directly from the liver to the small intestine. In case the tumour involves the liver, a combined liver and bile duct resection is performed to remove the damaged part of the liver along with the bile duct and the gallbladder.
- Pancreaticoduodenectomy or Whipple Procedure
It is a complex operation performed to remove the duodenum, the gallbladder, the head of the pancreas and bile duct. It can also be used in the treatment of tumours and other disorders of the pancreas, intestines and the bile duct. After the procedure is complete, the surgeon reconnects the remaining organs to enable the patient to digest food normally.
The Whipple procedure is generally recommended in case of the following conditions.
- Pancreatic cancer
- Cysts in the pancreas
- Tumours in the pancreas
- Cancer of the bile duct
- Cancer of the small bowel
- Ampullary cancer
- Pancreas trauma
- The trauma of the small intestine
- Neuroendocrine tumours
The Whipple Procedure aids to extract the tumour and stop the spread of cancer to the other parts of the body. It can be done as open surgery, laparoscopic surgery, or robotic surgery depending on the complexity of the procedure, and the location of cancer.
- Biliary Bypass
The Biliary bypass surgery involves going around a blockage in the bile duct. A blockage can result in pain, itching, jaundice, liver failure, etc. With Biliary surgery, the bile can flow out of the liver to the gallbladder or small intestine and relieve the patient of the symptoms caused by a blockage. The procedure is recommended when other types of surgery are not useful to remove the blockage.
The surgery can be performed either in open surgery, laparoscopic or robotic methods. It is performed under general anaesthesia. The doctor makes a cut in the bile duct before the blockage, he will also make another cut in the bile duct or the small intestine after the blockage. He then connects both the openings to create a new path for the flow of bile. The incisions are closed with sutures and drain tubes may be inserted to absorb excess fluids.
Liver transplant surgery is an extremely complicated procedure that requires experience and expertise. Choose Narayana Health for the best liver transplant hospital in India with the world’s best team for liver transplant and HPB surgery.
Treatment Process For Liver diseases
Accurate diagnosis plays a crucial role in the determination of the treatment process for liver diseases. There are 3 types of tests that help in the diagnosis of the liver and biliary diseases.
- The first step of the process starts with blood tests such as liver function tests that help the doctors to ascertain your genetic conditions and specific liver problems.
- The blood tests are followed up with imaging tests such as MRI, CT Scan and Ultrasound scans to figure out the extent of damage to the liver and bile ducts.
- The surgeons may also conduct biopsy tests for proper diagnosis of tumours and other liver diseases.
The treatment process differs from one patient to another depending on the diagnosis, age, and the extent of the liver and biliary damage. The early stages of liver and biliary diseases can be treated with medicines and lifestyle changes. However, some serious liver problems require surgery or liver transplant.
How to Choose the Best Liver Transplant Hospital in India For Your Liver Transplant and HPB Surgery?
- Team of Specialists - The hospital should have a team of superspecialists who are experts in treating end-stage liver diseases using advanced treatment procedures. The team must consist of renowned doctors and surgeons in the liver and biliary surgery for pediatric and adult patients.
- Robotic Surgical Platform - The hospital should have expertise in using the robotic surgical platform for conducting liver transplant and HPB surgery. Choose a hospital that uses the advanced da Vinci surgical system to conduct various liver and HPB surgeries.
- Accreditation - The hospital should be accredited by NABH and JCI, which are proof of world-class standards in healthcare.
- Dedicated International Division - If you are not an Indian resident, it is preferable to choose a hospital with a dedicated International division to facilitate a smooth treatment process for overseas patients. The international services must include concierge service, language interpretation services, visa invitation letter, medical opinion, and a host of other services to make your treatment process smooth and convenient.
- Modular Operation Theatres - Choose liver transplant hospitals that have modular operation theatres, which comply with international standards. The operation theatres must be equipped with the latest technology and advanced monitoring systems that aid the surgeons to perform liver and HPB surgeries with precision.
Liver Transplant & HPB Surgery FAQ's
The hepatobiliary and pancreatic system consists of the liver, pancreas, gallbladder, and bile duct. A hepatobiliary surgeon performs surgery to treat cancers and disorders in these organs. Some common procedures followed in hepatobiliary and pancreatic surgery include – Liver transplant and liver resection, cholecystectomy for gallbladder removal, pancreatectomy or removal of the pancreas, bile duct resection and reconstruction, etc.
The HIDA scan is also known as cholescintigraphy or hepatobiliary scintigraphy. It is an imaging test that involves injecting a radioactive tracer into a person’s veins to show the functioning of the liver, bile ducts, gallbladder, and small intestine. Through a special camera, the tracer’s movements can be tracked, and images can be transmitted onto a computer screen for observation and diagnosis.
In most cases, liver cancer doesn’t show any signs or symptoms in its primary stages. However, some of the symptoms that can appear are - loss of weight and appetite, pain in the upper abdominal region, fatigue, abdominal swelling, nausea, yellow discolouration of the skin and eyes, white and chalky stools.
Whether you are receiving a liver transplant or donating a liver, you can resume your normal life within a few months of surgery. Usually, the liver will regain its standard size by the time you hit the three-month mark.
It is normal for donors to feel a little weak and tired after the surgery. They might feel some pain as well, but that can be relieved easily with pain medications. It’s recommended to get a checkup after two weeks of surgery, and then at regular intervals.
There is a chance that some liver diseases might reappear in the new liver. Hepatitis C is one such example. After a liver transplant, the transplant team will advise you on the occurrence of specific liver diseases and conditions. Moreover, the team will monitor the patient closely to prevent any risks or chances of recurrence of diseases.
Liver transplantation is treatment for end stage liver disease (liver cirrhosis), liver tumors, metabolic liver diseases and acute liver failure.
Liver transplant recipients can lead a normal life with some precautions and restrictions after initial recovery from surgery which can take upto 3 months.Dietary restrictions to accommodate immunosuppressive medications, healthy diet/lifestyle and exercise to avoid weight gain and lifestyle modification to avoid infections.
HPB surgeries for Benign and malignant diseases of the liver, biliary tree and pancreas.Conventional open and minimally invasive approaches (Laparoscopic and Robotic).Treated HPB diseases include:
- Hepatocellular carcinoma
- Cancer of bile duct (Cholangiocarcinoma)
- Gall bladder cancer
- Liver Metastases
- Pancreatic Cancer
- Choledochal cysts
- Biliary stricture
Liver transplant extends life expectancy (Survival rates of 90% at 1 year and approaching 70% at 10 years post liver transplant) and enhances quality of life for liver transplant recipients.
Living donor liver transplant
Deceased donor liver transplant