An HPB surgeon treats surgical problems of the liver, pancreas, bile ducts and related organs. HPB stands for hepatopancreatobiliary, and complex HPB diseases include tumours, blocked or narrowed bile ducts, serious pancreatic conditions and advanced liver disease. Depending on the condition, care may involve monitoring, medicines, procedures, surgery or, in some cases, transplantation. A hepatopancreatobiliary surgeon rarely works alone, because complex cases need careful planning and input from more than one specialist. This article explains, in plain language, how these conditions are assessed and treated, and what patients can generally expect.
Key takeaways:
Complex HPB diseases are difficult conditions of the liver, pancreas, bile ducts, and related organs that often need specialised assessment. When only the liver and bile ducts are affected, they may be called complex hepatobiliary diseases. An HPB surgeon may be involved in their care.
The management of complex HPB conditions begins with a careful, step-by-step evaluation by a hepatopancreatobiliary surgeon.
Together, these steps help the team understand what is wrong, how far it has spread or progressed, and which treatments are suitable. No single test decides the plan; results are considered together.
The treatment of complex liver diseases depends on the specific liver problem, and no single approach suits every patient.
Liver resection means removing the part of the liver that contains a tumour or other disease, along with some healthy tissue around it. Depending on the size and position of the problem, this can range from a small section to a large part of the liver. Some selected operations may use minimally invasive or robotic techniques.
Liver transplantation may be considered when the liver is severely damaged and other treatment options are not suitable. It can use a liver from a deceased donor or part of a liver from a living donor. Careful assessment of the patient, and of the donor when one is involved, is essential.
Some complex liver conditions need surgery alongside other treatments, such as chemotherapy, medicines, or procedures. No single treatment works for every patient, so the plan is tailored to the individual.
The choice depends on the cause, the extent of disease and the patient’s overall health.
Complex pancreatic diseases and complex biliary diseases are treated according to their cause, location, and severity.
Depending on the condition, treatment may include monitoring, medicines, procedures, or surgery. For pancreatic cancer, the operation depends on where the tumour is. The Whipple operation is the most common and is used for tumours in the head of the pancreas: it removes the head of the pancreas, the gallbladder, part of the bile duct, and part of the small intestine, sometimes with part of the stomach, and then reconnects the digestive tract. A distal pancreatectomy removes the tail of the pancreas, and sometimes the spleen with it when the tumour lies there. After pancreatic surgery, some people need enzyme capsules to help digest food, and diabetes can develop. Read more about pancreatic surgery.
Pancreatic cysts are handled differently because they vary. A serous cystadenoma is usually not cancerous and can often be watched. Mucinous cystic neoplasms and IPMNs carry some risk of becoming cancerous, so they are either monitored closely or removed, depending on their type, size, and other features. Not every cyst needs surgery.
Bile duct problems may involve blockage, narrowing, infection or tumours. A blocked duct causes jaundice and needs to be opened. This is often done first with ERCP, in which a flexible camera is passed through the mouth into the small intestine so that a small tube (stent) can be placed in the duct to let bile drain. If a stent cannot be placed this way, a drain can be passed through the skin and liver into the bile duct (PTBD), which can also relieve jaundice before surgery.
For bile duct cancer (cholangiocarcinoma), surgery is the main treatment when the whole tumour can be removed. Depending on where it is, the operation may remove part of the bile duct, part of the liver, or both, or it may be a Whipple operation. Some bile duct tumours require complex surgery. If a tumour cannot be removed, stents or bypass procedures can still relieve the blockage. Read more about bile duct cancer surgery.
In both areas, the team first confirms the diagnosis with tests and imaging, then weighs the benefits and risks of each option. Not every patient needs surgery, and some conditions are best managed without it. The final plan is agreed with the patient after a full assessment.
The management of complex HPB conditions is a coordinated process, not simply an operation, and follows a clear framework:
This matters most in complex hepatobiliary diseases such as bile duct tumours near the liver, where the plan may involve draining a blocked duct first and then planning surgery. The aim is always to choose the most suitable treatment for the individual patient, rather than simply to operate.
An HPB surgeon may be recommended when a liver, pancreas, bile duct, or related condition may require specialised surgical assessment. Referral to a hepatopancreatobiliary surgeon may be appropriate for:
Your general doctor can advise whether a referral is needed.
Dr. Prashant Kadam is a senior consultant in liver transplant and HPB surgery at Sir H. N. Reliance Foundation Hospital, Girgaon, Mumbai. His areas of practice, as listed on his profile, include complex liver resections, pancreatic surgery, surgery for gallbladder cancer and gallstone disease, complex bile duct reconstruction and repair, and liver transplantation. He trained in HPB surgery and liver transplantation at Queen Elizabeth Hospital, Birmingham, and his profile states that he is trained in robotic liver surgery. You can read more about HPB surgery in Mumbai on his website.
Medically reviewed by Dr. Prashant Kadam | Last reviewed: October 2026
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Complex HPB diseases are difficult conditions affecting the liver, pancreas, bile ducts, and related organs. They may need specialised diagnosis, treatment planning, procedures, or surgery, depending on the cause, location, and severity of the problem.
An HPB surgeon treats complex surgical conditions involving the liver, pancreas, bile ducts and gallbladder, including tumours, blockages and other serious problems. Treatment is chosen after individual assessment and may not always involve an operation.
A hepatopancreatobiliary surgeon, or HPB surgeon, is a surgical specialist trained to manage conditions affecting the liver, pancreas, bile ducts, and related organs. They often work with other specialists to plan the most suitable treatment.
Treatment depends on the cause and may include monitoring, medicines, procedures, liver resection (removing part of the liver) or, when appropriate, liver transplantation. The treatment of complex liver diseases is planned after assessing each patient’s condition, test results and overall health.
Treatment depends on the cause and may include a stent placed during ERCP, or a drain placed through the skin (PTBD), to open a blocked duct, as well as surgery or other treatment when appropriate. The treatment of bile duct diseases varies with the cause, location and extent of the problem.
You may need Hepato-Pancreato-Biliary Surgery if you have a complex condition affecting the liver, pancreas, bile ducts or gallbladder that requires specialised surgical assessment. A specialist will review your diagnosis and overall health to determine whether surgery, another procedure or non-surgical treatment is the most suitable option.
This article is for general information only and does not replace medical advice. Diagnosis and treatment depend on individual assessment by a qualified doctor.