Hepato-Pancreato-Biliary (HPB) Unit
Central Manchester University Hospitals NHS Foundation Trust HPB
(hepato-biliary) Unit is the regional centre that provides highly
individual, specialist services for patients with benign
(non-cancerous) and malignant (cancerous) diseases of the
liver, biliary system and pancreas. We are the
designated Regional Pancreatic Centre (in conjunction with our NMG
colleagues), and are the largest most specialised HPB units in the
region, treating patients from Manchester and surrounding areas. We
are a tertiary referral centre, and a nationally recognised centre
of excellence for pancreatic cancer.
The HPB Unit works closely with the other acute hospital trusts
in the Greater Manchester area - these include: Bolton NHS
Foundation Trust; East Cheshire NHS Trust; Pennine Acute NHS Trust
; Salford Royal NHS Foundation Trust; Stockport NHS Foundation
Trust; Tameside Hospital NHS Foundation Trust; The Christie NHS
Foundation Trust; University Hospital of South Manchester NHS
Foundation Trust; Wrightington, Wigan and Leigh NHS Foundation
Trust;
Many patients with a hepatobiliary problem require endoscopic
ultrasound or ERCP, or others may require procedures involving
X-ray.
If you need to be admitted for a procedure this will usually be
to AM3 or AM4 (the gastroenterology wards) or the
surgical ward.
Please click here for the X-ray department.
Please click here for the Endoscopy pages.
We provide a multi-disciplinary service with a team of
experienced surgeons (Link to Surgeons), gastroenterologists (Link
to Gastro), radiologists (Link to Radiology), pathologists,
anaesthetists, oncologists, intensive care physicians, nurse
specialists and dieticians, all dedicated to providing the
best possible care for each and every individual
patient.
Our patients are discussed in our weekly multi-disciplinary
team meeting (Wednesday's) giving the opportunity for review of
your care and treatment by every member of our team. This ensures
that the treatment that we deliver to you is the best we can offer
and can also help speed up the organisation of any further
investigations you might need.
We also have a team of HPB Clinical Nurse
Specialists (Link to CNS contacts) who
can provide you with advice and support on all aspects of your
care, from the point of diagnosis throughout your treatment
and follow-up care.
What we do
We provide all-round care for people with liver, pancreatic,
biliary and gall bladder disorders. Our team offers specialist
investigations and care for conditions such as:
We treat all types of biliary, pancreatic and liver diseases
including:
- primary liver cancer: hepatocellular carcinoma (HCC)
- benign liver tumours: focal nodular hyperplasia (FNH), adenoma,
haemangioma
- biliary disease- gallstones, PSC
- biliary cystadenoma
- primary biliary cancers: cholangiocarcinoma and gallbladder
cancer
- pancreatic disease- pancreatitis, pancreatic cancer
- secondary liver tumours from a colorectal, breast or other
primary
- chronic and acute pancreatitis
- complex benign hepato-biliary and pancreatic conditions.
- Liver disease- viral hepatitis, cirrhosis
Treatments include:
- liver, pancreatic and biliary resection
- percutaneous radio-frequency ablation of primary and secondary
liver tumours
- percutaneous chemo-embolisation for primary liver tumours
- percutaneous bland embolisation for liver tumours
- endoscopic radio-frequency ablation for biliary tumours
- Selective Internal Radiation Therapy (SIRT) for primary or
secondary liver tumours subject to individual patient funding
- sorafenib for primary liver cancer - hepatocellular carcinoma
(HCC) - subject to individual patient funding or by clinical
trial
- specialist endoscopy.
Patients are assessed and reviewed by our consultant
oncologists at CMFT. Systemic chemotherapy and/or radiotherapy is
provided at The Christie Hospital NHS Foundation Trust.
One-Stop Jaundice
Clinic
The One-Stop Jaundice clinic is held every Monday morning
by the Jaundice CNS. Patients can be referred by their GP or local
hospital by contacting the Jaundice CNS (link to aileen.aherne@cmft.nhs.uk
or 07973 947 137). The aim of the clinic is to provide same
day definitive radiological imaging for patients presenting with
obstructive jaundice not due to gallstones. The purpose is to
provide for earlier diagnosis and timely referral and to improve
patient experience.
Fast-track
Surgery
Jaundiced patients with a suspected pancreatic head tumour
or cholangiocarcinoma can be referred for consideration of
Fast-track surgery by their referring hospital. The aim of this is
to proceed straight to surgery (within 1 week) thus avoiding
preoperative biliary drainage (if bilirubin <350).
Research
The National Institute for Health Research (NIHR)
demonstrates that the clinical research network (CRN) for Greater
Manchester is nationally, the lead recruiter for HPB. The CMFT HPB
Unit is currently participating in the following NIHR portfolio
studies:
PANasta: Cattall Warren
versus Blumgart techniques of panreatico-jejunostomy following
pancreato-duodenectomy - a double blinded multi centred
trial
ESPAC-5F: a multi-centre,
prospective, randomised, feasibility Phase II trial comparing
neoadjuvant therapy to immediate surgical exploration in patients
with borderline resectable pancreatic cancer.
What to
expect
Your first appointment
You may have had your first appointment in your local hospital
and then been referred on to the CMFT HPB team. During your
appointment with us we will discuss possible diagnoses and any
investigations (tests) that we may need to do. You will meet a
dedicated HPB Clinical Specialist Nurse (CNS) who will keep in
contact with you and give you all the information you need.
We may need to carry out certain investigations to help find a
diagnosis. These are performed as quickly as possible and your CNS
will keep in contact with you with up-coming dates.
After your first appointment and
investigations
Every Wednesday members of the HPB team including surgeons,
specialist nurses, radiologists, histopathologists and oncologists
meet to discuss the results of patients' investigations in the
Multi-disciplinary team meeting (MDT). They will decide on a
management plan for each patient, which could include surgery,
chemotherapy or palliation (relieving) of distressing symptoms
caused by the cancer.
We will ask you back to the clinic soon afterwards so that the
HPB surgeon and your specialist nurse can explain your treatment
options. If surgery is planned you may also see a physiotherapist
who will advise you on breathing/coughing and mobility after
abdominal surgery and a dietician who will advise you on
nutritional supplements and healthy eating during your
treatment.
Pre-admissions clinic
If surgery is planned you will be asked to attend a
pre-admissions clinic at the Elective Treatment Centre. At this
appointment a nurse will assess take your bloods, perform an ECG,
and arrange any additional tests needed and give you any relevant
information about your hospital admission. You may also need to
have a CPET (Cardio Pulmonary Exercise Test) to assess your level
of fitness prior to any planned surgery. An invitation for Surgery
School will also be sent to you, where you will have the
opportunity to meet the anaesthetist, dietician and
physiotherapist. The CNS will try to co-ordinate these appointments
for the same day.
Surgery School
Pre-habiliatation
On the day of the operation
You will be admitted the evening before your surgery and this is
usually to Ward 8 (HPB Ward). The nursing staff will prepare you
for surgery and you will get another opportunity to see the surgeon
and meet the anaesthetist. Please feel free to ask any
questions.
We will discuss your anaesthetic including the use of specific
intra-operative monitors and methods of post operative pain relief such as epidurals and morphine PCAs. We will also
discuss where you need to be cared for after the operation. For
smaller operations such as laparoscopic cholecystectomies, you will
have a bed on a general ward after the operation, and may be able
to go home later that day. For major operations such as liver or
pancreas surgery, you will probably need closer monitoring and care
on a critical care ward (HDU or ICU). If this is the case we will
have to confirm that this bed is available before surgery can go
ahead.
The anaesthetic room
When you are brought down to theatre you will meet an ODP
(operating department practitioner) who works with the
anaesthetist. The team will go through a few further safety checks
before they start your anaesthetic.
You will have a cannula (small plastic tube) put into a vein and
routine monitoring will be attached. If you need an epidural, this
will normally be put in with you awake at this point. You will be
given oxygen to breathe as you are given the anaesthetic drugs that
drift you off to sleep in your cannula. You are kept asleep by
breathing in special anaesthetic gases through a breathing tube.
These gases are continuously monitored by your anaesthetist to
ensure you are safely asleep throughout the operation. Whilst you
are asleep other monitors may be inserted to help your anaesthetic
team care for you. These may include an arterial line (measures your blood pressure),
a central line (allows the administration of
drugs) and a urinary catheter. Depending on the complexity of your
operation you may be asleep from between one and six hours.
Post operatively
Once your operation is over you will be woken up and taken to
the recovery room and then moved on to either the ward or critical
care, or very rarely you may be kept asleep and moved to the ITU to
be woken up later on.
This depends on your pre-operative health, the complexity of the
operation, how well you have coped with the surgery and how well
the surgery has gone.
In recovery
Following HPB surgery the majority of patients go to the
recovery area. During this time, as you wake up from your
anaesthetic, specialist nurses monitor your vital signs and ensure
your pain relief is effective and any nausea is treated. Once your
condition is stable you will be moved either back to the ward or to
critical care.
In critical care
Once you have recovered from the general anaesthetic you will be
able to start drinking on the day of the operation and eating the
day after. This is important because improved nutrition after the
operation has been shown to speed recovery and reduce serious
complications.
Intensive care consultants and your surgical team will review
you on daily ward rounds to ensure you are progressing well after
your operation. As your condition improves over the first two days
after surgery abdominal drains, urinary catheters and other drips
will be removed. If you have an epidural, this will be reviewed on
a daily basis by the acute pain team and it is usually removed on
the third post-operative day, when you will be converted on to
tablet pain killers.
Once the critical care team is happy with your progress you will
be moved to the dedicated HPB ward where your post-op care and
rehabilitation will continue until you are discharged home.
The enhanced recovery programme
In Manchester, we use an enhanced recovery programme to help you recover
from the operation and return to normal activities faster with less
chance of developing complications like blood clots in the legs and
lungs or chest infections. It also means that you will be able to
get home earlier. On average patients undergoing open liver
resection are discharged six days after surgery. The majority of
patients who have had complex surgery such as operations for liver
or pancreatic cancer will spend their first few post-operative days
in a critical care unit. Here you will have your own dedicated
nurse who will monitor you round the clock and will ensure that
your vital signs are stable and that your pain control is
effective. We will monitor your temperature, pulse, blood pressure
and fluid balance.
Regular breathing exercises, sitting out of bed and walking
reduce rates of chest infections, blood clots in the legs and lungs
and help you get home quicker. After you wake from the operation
you should start breathing exercises. Support your abdomen with
your arms. A physiotherapist will take you through these exercises
every day. You can help reduce the risk of developing a blood clot
by performing specific leg exercises, wearing compression stockings
and having daily injections of a drug that thins the blood.
The day after the operation the staff will help you out of bed.
You will spend several hours out of bed each day and will be
encouraged to walk around (with the help of the staff initially)
3-4 times per day. At first this will feel like hard work but being
out of bed and mobilising early improves lung function and reduces
the risk of blood clots. You will be seen every day by your
surgical team who will review your progress and decide when it is
safe for you to go home.
Follow-up clinic
You will normally be seen in the out-patient clinic, at
Manchester Royal Infirmary, four to six weeks after you are
discharged home. This allows us to check you are progressing as you
should be. This appointment will be given to you before you leave
hospital or sent to you at home. Your doctor may discuss with you
the need for further treatment such as chemotherapy. If
necessary, arrangements will be made for you to see an oncologist
(a doctor who specialises in chemotherapy treatment). He/she will
discuss this treatment option with you further and give you chance
to ask questions. You will be given time to recover from your
operation first before undergoing any further treatment such
as chemotherapy.
Following this appointment you will have a CT scan three months
after your surgery to look at the re-growth of your liver, which
will act as a baseline for all future scans. You will then have CT
scans yearly and will be contacted or seen in clinic with the
results.
If you experience any problems before your hospital appointment,
please contact your consultant's secretary or you Clinical Nurse
Specialist, who can advise you accordingly. If you feel it is
becoming an emergency then the Emergency Department at CMFT is open
24 hours and will be able to make sure you are reviewed by the
appropriate doctor.
Meet the team
Our gastroenterolgy consultants who specialise in hepatobiliary
medicine are:
Dr. Richard Hammonds, Dr. Alistair Makin, Dr. Jo Puleston and Dr. Joe Geraghty.
They work very closely with the hepatobiliary surgical
consultants who are Mr Nicola De' Liguori- Carino, Mr Rahul
Deshpande, Mr Saurabh Jamdar, Professor Derek
O'Reilly, Mr Thomas Satyadas, Professor Aali Sheen and Prof. Ajith Siriwardena.
Specialist nurses include Sr. Aileen Aherne, Sharan Ingram,
Adele McNeillie, Alison Maugham & Sr. Claire Newton.
Professor Ajith Siriwardena
Professor Ajith Kumar Siriwardena
MBChB, M.D., FRCS, Is
the current professor of hepato-pancreatico-biliary surgery at
the University of Manchester, and
a consultant hepatobiliary surgeon at the Manchester Royal Infirmary.
Qualified in medicine from the University of Manchester and trained
in surgery in Manchester and Edinburgh. Undertook advanced liver
surgical training in Paris and worked as a consultant in the
national liver surgery unit in Scotland. Currently provides
expertise in liver surgery and pancreas surgery, especially for
patients who have had bowel cancer and have then developed
metastases in the liver.
Professor Aali Sheen
Consultant General & Gastrointestinal Surgeon
MD MBChB FRCS(Eng) FRCS(Gen)
Professor Aali Sheen was appointed Consultant Surgeon at
Manchester Royal Infirmary in 2005 as a General Surgeon with a
specialist interest in Hepatopancreatobiliary (HPB) and
Gastrointestinal Surgery. In his time as a Consultant he has taken
an interest and developed a reputation in hernia surgery, for which
he has a seat on the council of the British Hernia Society and on a
subcommittee for the European Hernia Society.
Professor Sheen is well published in the field of hernia
and hepatobiliary surgery and has been granted a Hon/Vis personal
chair in surgery by Manchester Metropolitan University
(MMU).
Professor Sheen has an international profile and is well
known for his work on 'Sports Hernias' and consequently attracts
elite athletes from around the world. He published the first
consensus statement of the sports groin, which he re-defined as
'inguinal disruption'. In March 2011 he was awarded a 'Visiting
Professorship' in the United States for his hernia
expertise. He has a reputation for undertaking difficult and
challenging cases as well as being a renowned laparoscopic surgeon
in his field.
Professor Sheen was born and educated in London and went
to medical school in Scotland. His main social interests include
skiing as well as physical fitness.
Mr Thomas Satyadas
Consultant General Surgeon UMD DipHPB FRCS (Ed) FRCS
(Eng) FRCS (Gen Surg)
Mr Satyadas is an advanced laparoscopic surgeon with extensive
subspecialty training in liver and pancreas surgery (HPB). After
completing his Basic Surgical Training in London, Mr Satyadas
undertook a period of surgical science research at the Royal Free
University Hospital, London. His Higher Surgical Training was in
the Cambridge Deanery. During this time he also obtained travelling
fellowships to the world-renowned European Pancreatic Cancer Centre
in Heidelberg and Liver Cancer Centre at the Virchow Klinikum in
Berlin.
Mr Satyadas completed his specialist training at the liver and
pancreas surgery (Hepato-Pancreato-Biliary¬) Unit in Cambridge.
From there he pursued further specialist training by obtaining the
fellowship at the Liver and Pancreatic Cancer Unit at the
University of Adelaide for a period of 16 months. On completion, he
worked in Paris for 6 months as a Laparoscopic liver and pancreas
fellow.
The specialist training and prestigious overseas fellowships Mr
Satyadas received in the UK (London and Cambridge), Europe (Paris,
Heidelberg, Berlin) and Australia has provided him with extensive
experience in performing complex General and
Hepato-Pancreato-Biliary Surgical operations.
Mr Satyadas has been trained and has excellent experience in
performing repeat hepatectomies for colorectal liver metastases. He
has also developed specialty interest in minimally invasive
"key-hole" surgery. Throughout his practice he has consistently
provided best surgical managements for his patients in both cancer
and non-cancerous surgery. Mr Satyadas has a passion for surgical
innovation and believes in enhanced recovery after surgery.
Whenever it is indicated, he will offer "key-hole" surgery to his
patients e.g. laparoscopic cholecystectomy, laparoscopic removal of
bile duct stones and laparoscopic hernia (all types) and
laparoscopic and liver and pancreas surgery.
Mr Saurabh Jamdar
General and Hepato-Biliary Surgeon BSc(Hons), MB ChB, MD,
FRCS (Gen Surg)
Mr Jamdar graduated from the University of Manchester. He
undertook his surgical training in the North West of England
including a period of research studying pancreatic disease at the
University of Manchester. He completed his surgical training with a
fellowship at the prestigious HPB and Liver transplant unit at
Addenbrooke's hospital in Cambridge.
His main clinical interests are diseases of the liver, pancreas
and gallbladder. Mr Jamdar has an interest in advanced laparoscopic
surgery and abdominal hernia repair. Mr Jamdar supports the
principles of enhanced recovery after surgery (ERAS) and provides
this evidence based care to all patients undergoing surgery.
Since completing an MD thesis at the University of Manchester as
a surgical registrar Mr Jamdar has a maintained a keen interest in
high quality research and is actively involved in a number of
research projects related to liver, pancreas and gallbladder
surgery. He is currently the local principle investigator for a
large multi-centre study examining the outcomes from gallbladder
surgery (The CholeS study).
Professor Derek O Reilly
PhD FRCS
Mr Derek O'Reilly PhD FRCS is a consultant surgeon at the
Manchester Royal Infirmary, specialising in Hepatobiliary and
Pancreatic (HPB) Surgery. He is the Greater Manchester Cancer HPB
Pathway Clinical Director for and an Honorary Clinical Professor at
the Institute of Cancer Science, University of Manchester,
Manchester Academic Health Science Centre, United Kingdom.
He is an NCEPOD Clinical Coordinator and was the lead author of
'Treat the Cause' - A review of the quality of care provided
to patients treated for acute pancreatitis. He is currently a
member of the National Institute for Clinical Excellence (NICE)
clinical guidelines committee for pancreatic cancer.
Mr Nicola de Liguori Carino
Mr Nicola de' Liguori Carino is Consultant General Surgeon who
specialises in laparoscopic (keyhole), hepatobiliary and pancreatic
(HPB) surgery. His main interests are in disease of the liver,
gallbladder, biliary system and pancreas. He also has an extensive
practice in hernias repairs. He completed his surgical training in
Italy with a period spent at the Ohio University Hospital,
Columbus, USA. Before being appointed as a Consultant in
Manchester, Mr de' Liguori Carino spent 4 years training in HPB and
transplant surgery at the University of Liverpool and Leeds. His
unit at Manchester Royal Infirmary, University of Manchester, is
one of the largest HPB unit's in the UK and Europe.
He has experience in the treatment of gallstone disease with the
most modern techniques with emphasis on rapid access to treatment
and recovery. Mr de' Liguori Carino performs laparoscopic
cholecystectomy, laparoscopic and open hepatobiliary (liver),
pancreatic and digestive surgery, including very complex liver,
biliary and pancreatic resection. He also treats a consistent
number of hernia cases with both laparoscopic and open approach. He
is committed in liver and pancreas cancer research programs taking
part in multiple ongoing clinical trials.
Mr Rahul Deshpande
Research
The CMFT HPB Unit is currently participating in the following
NIHR portfolio studies:
PANasta: Cattall Warren versus Blumgart
techniques of panreatico-jejunostomy following
pancreato-duodenectomy - a double blinded multi centred trial
ESPAC-5F: a multi-centre, prospective,
randomised, feasibility Phase II trial comparing neoadjuvanttherapy
to immediate surgical exploration in patients with borderline
resectable pancreatic cancer.
Useful links:
AMMF - The Cholangiocarcinoma Charity: www.ammf.org.uk
Cancer Research https://www.cancerresearchuk.org/
Macmillan www.macmillan.org.uk
NHS Choices: Pancreas Cancer:
http://www.nhs.uk/conditions/Cancer-of-the-pancreas/Pages/Introduction.aspx
Pancreas Cancer UK https://www.pancreaticcancer.org.uk/
Pancreas Cancer Action https://pancreaticcanceraction.org/
PBC Support: https://www.pbcfoundation.org.uk/
PSC Support: http://www.pscsupport.org.uk/
St Anns Hospice http://stannshospice.wpengine.com/
Willow Wood http://www.willowwood.info/
Winstons Wish
http://www.winstonswish.org.uk/?gclid=CMyOiKni2NICFSIL0wodPZgBgw
