Liver, Biliary and Pancreatic Surgery

Procedures Offered

Guthrie’s hepatobiliary specialists offer a comprehensive array of liver, pancreatic and biliary procedures. Choose from the options below to learn more.

Liver Procedures
Biliary (Bile Duct) Procedures
Pancreatic Procedures

Liver Procedures

Ablation – destruction of abnormal liver tissue using a variety of methods. The advantages of ablation include sparing normal tissue and permitting treatment of multiple tumors in different places on the liver. Ablation methods are often used in conjunction with surgical removal of portions of the liver. This options has increased the number of patients who are candidates for surgical treatment. Ablation options include:
- Radiofrequency Ablation (RFA) -- destroys the tumor using heat generated by high- frequency alternating current delivered to the tumor by uninsulated electrode tips. As the temperature is increased above 113 degrees Fahrenheit (45 degrees Celsius), cell proteins in the tumor degenerate and cell structure is lost, destroying the tumor.
- Cryoablation -- Cryosurgery is a recent advance in the surgical treatment of various cancers, including liver cancer, prostate cancer and kidney cancer.
Ethanol Injection –100% absolute alcohol is injected into a tumor to destroy it. This treatment is for patients who choose not to have surgery or who have severe liver disease that will not permit surgery. This was the first method of liver ablation pioneered, and while still performed, it is no longer common.
Hepatic Artery Infusion Pump – delivers chemotherapeutic agents directly to the liver using a continuous-flow pump. This type of chemotherapy is often very effective because the blood that feeds liver tumors is supplied by the hepatic (liver) artery, so pumping chemotherapy directly into the hepatic artery delivers the drugs right into the tumors. Direct infusion to the tumor area also means a higher dose and a higher concentration of drugs can be administered, and also decreases systemic side effects.
Liver Resection – Surgical removal of portions of the liver damaged due to cancerous or benign tumors or cysts or other disease.

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Biliary (Bile Duct) Procedures

Bile Duct Strictures – drainage or dilation of the stricture.
Cholangiocarcinoma (bile duct cancer) – there are several treatment options:
- Surgical removal of the entire bile duct
- Whipple Procedure (or pancreaticoduodenectomy) for tumors that involve the lower third of the bile duct and the area called the common duct, which is where the bile duct and pancreatic duct empty into the duodenum.
- Bile duct resection and reconstruction
- Proximal hilar (Klatskin’s) tumors are more difficult to treat surgically because they are close to the liver, and removing them usually involves removing some liver tissue as well. During this procedure, the surgeon also places titanium clips in the surgical area to help radiation therapists target a treatment area after surgery.
Cholecystectomy/Gall Bladder Removal – surgical removal of the gall bladder. This procedure can also be done laparoscopically.
Choledochal cysts (bile duct cyst) – surgical removal of bile duct cysts caused by an enlargement of the bile duct due to a congenital abnormality
Gall Bladder Cancer – treated with surgery, radiation therapy or chemotherapy.
Gall Bladder Removal/Cholecystectomy – surgical removal of the gall bladder. This procedure can also be done laparoscopically.
Interventional Radiology Procedures – Guthrie’s interventional radiologists offer a variety of procedures related to the liver, bile duct and pancreas, including stent placement, stone removal, angiograms, balloon dilation of strictures and access to the biliary tree via percutaneous transhepatic cholangiogram (PTC) to drain or dilate the bile duct due to obstruction
Laparoscopic Common Bile Duct Exploration With Laser Lithotripsy -- exploration of the bile duct and the simultaneous destruction of any bile duct stones in the bile duct. Two procedures are usually required to remedy this problem – one to explore the duct and a second to destroy any stones found during the exploration. The procedure works by making several small incisions in the abdomen to accommodate a videocamera and long, thin surgical instruments. The surgeon passes a balloon through one of the incisions and dilates the bile duct. A small scope is then introduced to look for bile duct stones. If stones are found, an extremely thin laser fiber is passed through the scope and used to pulverize the stones. The area is irrigated and the pieces of the stones are eliminated through the intestines. Although the procedure has been available for nearly a decade, Robert Packer Hospital is the only medical facility in the region to offer this minimally invasive option.
Percutaneous Transhepatic Cholangiogram (PTC) – gives an interventional radiologist physician access to the biliary tree through a large needle that passes through the skin and muscle into the liver to drain or dilate the bile duct due to obstruction. The procedure can also be used to introduce contrast media into the bile duct to produce an image of the stricture.
Repair of Bile Duct Injuries – accomplished in cooperation with the multidisciplinary services available under one roof at the Guthrie Clinic, including nutrition, interventional radiology, gastroenterology and more.

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Pancreatic Procedures

Endoscopic Retrograde Cholangiopancreatography (ERCP) -- enables a gastroenterologist to diagnose problems in the liver, gallbladder, bile ducts or pancreas, such as gallstones, inflammatory strictures (scars), leaks (from trauma or surgery) and cancer. ERCP combines the use of x-rays and an endoscope, a long, flexible, lighted tube. Through it, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays. ERCP allows the physician to produce images, dilate strictures with balloons, insert stents to facilitate further drainage or remove bile duct stones.
Pancreatic Debridement -- removal of dead pancreatic tissue or dead tissue around the pancreas.
Pancreatic Necrosectomy – removal of dead portions of the pancreas
Periampullary Tumors – treatment for tumors located in the area of the ampulla of Vater, which is a muscle that controls the common duct valve. The tumors can be in the area of the duodenum, the ampulla of Vater, the common duct or the pancreatic duct.

Pancreatic Resection Procedures:

Central Pancreatectomy -- connects distal (tail) portion of pancreas to intestine, head remains connected to gallbladder and duodenum
Distal Pancreatectomy – removal of the distal (tail) portion of the pancreas
Subtotal/Total Pancreatectomy -- surgical removal of portions of or the entire pancreas
Tumor Enucleation – removal of pancreatic tumors by "scooping" the tumor out of the normal pancreatic tissue
Whipple Procedure – for tumors that involve the lower third of the bile duct and the area called the common duct, which is where the bile duct and pancreatic duct empty into the duodenum.

Pancreatic Drainage Procedures

Cyst Entrostomy – removal of a specific type of non-cancerous growth on the pancreas, which can form due to damage caused during a bout of pancreatitis. Involves the internal drainage of the growth’s contents into the intestines, offering an alternative to the traditional open procedure that involves a large incision, an increased potential for infection, as well as increased pain and recovery time. Can be performed laparoscopically.
Cyst Gastrostomy – removal of a specific type of non-cancerous growth on the pancreas, which can form due to damage caused during a bout of pancreatitis. Involves the internal drainage of the growth’s contents into the stomach, offering an alternative to the traditional open procedure that involves a large incision, an increased potential for infection, as well as increased pain and recovery time. Can be performed laparoscopically.
Pancreaticoenterostomy – drainage of pancreatic duct into intestines