Hepatobiliary surgery (or hepatopancreatobiliary surgery) is a sub-specialty of General Surgery that focuses on the surgical treatment of diseases of the liver, gallbladder, bile ducts, and pancreas.

As the scope of General Surgery covers a very broad range of diseases, the rapid expansion of surgical knowledge for each organ and system, along with the differences in complexity and type of surgical interventions, has led to the formation of numerous specialized sub-disciplines within General Surgery.

Today, General Surgery has evolved into several sub-specialties, including Surgical Oncology, Colorectal Surgery, Hepatobiliary Surgery, Breast and Endocrine Surgery, Vascular Surgery, and Transplantation Surgery. Surgeons who wish to specialize in these fields gain advanced expertise by training in experienced centers after completing their General Surgery residency. In Türkiye, certain university hospitals and training & research hospitals have established dedicated units under these sub-branches.

Diseases Treated in Hepatobiliary Surgery

Although gallbladder-related diseases are the most commonly encountered in hepatobiliary practice, the most critical conditions treated include:

• Pancreatic cancer
• Ampulla of Vater cancer
• Gallbladder and bile duct cancers (cholangiocellular carcinoma)
• Liver cancer (hepatocellular carcinoma)
• Liver sarcomas

The liver is also the most frequent site of metastasis for cancers originating from the digestive system, especially colon cancer, as well as from other distant organs.

Non-tumoral conditions frequently treated by hepatobiliary surgeons include:

• Gallbladder and bile duct stones
• Obstructive jaundice
• Bile leaks and duodenal perforations following surgery or ERCP
• Hydatid cysts of the liver and related bile duct complications
• Pancreatic pseudocysts
• Benign and premalignant hepatic or pancreatic lesions

Treatment Approaches and Surgical Techniques

Cancers in the field of hepatobiliary surgery are particularly significant because they tend to progress rapidly and can be life-threatening. Management of these cancers requires a multidisciplinary approach involving specialists from General Surgery, Gastroenterology, Radiology, Medical Oncology, and Pathology.

Depending on the extent of disease, surgeons may remove part or all of the affected organ. Operations can be performed using laparoscopic, robotic, or open surgical techniques, with minimally invasive methods preferred in suitable cases.

In addition to surgery, various adjuvant and interventional treatments are employed, including:

• Systemic chemotherapy
• Radiotherapy
• Trans-arterial chemoembolization (TACE)
• Trans-arterial radioembolization (TARE)
• Radiofrequency ablation (RFA)
• Percutaneous ethanol injection

These combined approaches aim to increase survival rates and improve quality of life for patients with liver, pancreas, or biliary system cancers.