Hepatology & Liver Transplantation
Narayana Health has a multidisciplinary team of super-specialists experienced in treating End-Stage Liver Disease and performing liver transplantation.
Overview
The Liver Transplant and Hepato-Biliary and Pancreatic (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 that meets the criteria for liver transplantation. The hepatology team has extensive experience in complex hepatobiliary surgery for benign and malignant diseases using open and laparoscopic approaches. We are a reputed liver transplant hospital in India, trusted by patients across the world.
We pioneered the use of the robotic surgical platform for liver resections in India, with our work published in indexed surgical journals. Actively utilising the da Vinci surgical system, we handle hepatobiliary cases such as choledochal cyst resection with Roux-en-Y hepaticojejunostomy, liver cyst resection, and radical cholecystectomy. Our team of liver specialists has extensive experience in treating the full spectrum of liver and biliary diseases. With state-of-the-art equipment, our experienced liver transplant and HPB surgeons manage even the most complex cases.
Dedicated to delivering top-tier treatments at affordable prices, our centre specialises in managing liver diseases, cancers, and conditions of the bile duct, gallbladder, and pancreas. This commitment has earned us recognition as one of the leading liver transplant centres in India.
When Do You Need a Liver Transplant Surgery?
Liver transplant surgery is recommended when the liver gets damaged to an extent that is beyond the body’s regenerative capacity to repair and heal. It is generally performed when there is liver failure due to tumours, tissue scarring within the liver, liver diseases, or general diseases. The reasons for liver transplantation vary depending on the age of the patient.
Liver failure can occur quickly or gradually. Sudden loss of liver function is called acute liver failure while chronic failure occurs over months or even years. Major causes of damage to the liver can 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.
- Genetic diseases that affect the liver include hemochromatosis, which causes excessive iron buildup in the liver, and Wilson's disease, which causes 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 intestines are underdeveloped in children suffering from this condition. This condition can be corrected with reconstructive surgery in the initial few months after birth. But if the problem persists, the child may require 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 transplants and HPB surgery for young children.
Liver Transplant Surgery in Adults
There are many reasons for liver transplantation 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 by drug overdose
- Liver cirrhosis
Liver Transplant & Hepatobiliary Services at Narayana Health
We offer a wide range of liver treatments and hepatology surgery, such as:
Orthotopic Liver Transplant
Orthotopic liver transplantation is a surgical procedure in which a patient's diseased liver is removed and replaced with a healthy liver from a deceased donor, positioned in the exact anatomical location of the original organ. The surgery begins with a small incision in the abdomen to extract the damaged liver. The donor liver is then carefully positioned in place of the removed organ, and the surgeon meticulously connects all necessary blood vessels and bile ducts. After completing these connections, the incision is closed. To manage excess fluids, drainage tubes are inserted, and the patient is then transferred to the ICU for continued care and recovery.
Living Donor Liver Transplant
This surgical procedure involves transplanting a portion of a healthy living donor's liver into a patient with liver failure.
The liver specialist first performs surgery on the donor to remove a segment of the liver. Depending on the recipient's age, the surgeon may remove either the right or left lobe. The larger right lobe is typically recommended for adult recipients, while the smaller left lobe is better suited for children.
During the transplantation surgery, the surgeon makes an incision in the abdomen to remove the damaged liver. The appropriate lobe from the donor is then placed into position, and all blood vessels and bile ducts are carefully connected. After the connections are made, the incision is closed, and the patient is transferred to the ICU for continued care and recovery.
The donor's liver has the remarkable ability to regenerate, with the removed portion typically growing back to its original size and function within a few months. Similarly, the transplanted liver will grow and restore its size and function over time.
Split Donation Liver Transplant
Due to the anatomy of the liver, it can't be split evenly for transplantation. For a 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 liver halves are smaller than the entire organ, the surgery can benefit smaller patients who weigh between 100 and 160 pounds.
To maximise the benefits of each available donor organ, the two parts of the liver can be transplanted onto two different patients. This procedure is generally used if two patients require liver transplant surgery (one an adult and the other a child). The surgery is the same as the living donor liver transplant. The transplanted liver grows to its 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.
Hepatectomy
In hepatectomy, all or a part of the liver is surgically resected. The procedure removes tumours from the liver cells, called “hepatocytes”. It is used for patients suffering from localised 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 the part of the liver 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 a partial hepatectomy. In this procedure, the doctors remove only the diseased part of the liver and leave the healthy liver to regenerate and conduct 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 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 hepatology surgery 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 creates a path 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
This is a complex operation, performed to remove the duodenum, gallbladder, head of the pancreas and bile duct. It can also treat tumours and other disorders of the pancreas, intestines and bile ducts. 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 cases of:
- Pancreatic cancer
- Cysts in the pancreas
- Tumours in the pancreas
- Pancreatitis
- 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 in extracting the tumour and stopping the spread of cancer to the other parts of the body. It can be done as open, laparoscopic or robotic surgery, depending on the complexity of the procedure and the location of the cancer.
Biliary bypass
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 in removing the blockage.
The surgery can be performed as open, laparoscopic or robotic surgery, under general anaesthesia. The doctor makes a cut in the bile duct before the blockage, with another cut in the bile duct or the small intestine, after the blockage. They then connect both 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 fluid.
Liver transplantation surgery is an extremely complicated procedure that requires experience and expertise. Choose Narayana Health, 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 determining the treatment of liver diseases. Three types of tests help in the diagnosis of the liver and biliary diseases:
- The first step involves blood tests, such as liver function tests, which help doctors ascertain genetic conditions and specific liver problems.
- The blood tests are followed by imaging tests, such as MRI, CT scans and Ultrasound scans to identify the extent of damage to the liver and bile ducts.
- The surgeons may also conduct biopsy tests for the accurate 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 a liver transplant.
At Narayana Health, we ensure compassionate care and personalised treatment for liver and hepatology disorders to achieve the best possible outcomes.