When Is a Hepatobiliary Surgeon Needed?

For patients diagnosed with a condition affecting the liver, pancreas, bile ducts or gallbladder, understanding what comes next can feel overwhelming. Some conditions can be managed with medication, endoscopic procedures or ongoing monitoring, while others may require surgery or a combination of treatments.

Au Bui, M.D., a hepatobiliary surgeon with MemorialCare Todd Cancer Institute at Long Beach Medical Center, answers common questions about hepatobiliary surgery, the conditions these specialists treat and when patients may benefit from specialized surgical care.

What is a Hepatobiliary Surgeon?

A hepatobiliary surgeon specializes in diagnosing and surgically treating complex conditions involving the liver, gallbladder and bile ducts. Many also have advanced training in pancreatic surgery, known collectively as hepatopancreatobiliary, or HPB, surgery.

This focused training allows one specialist to evaluate diseases that may cross the boundaries between these closely connected organs and help guide patients from diagnosis through treatment planning.

What Conditions do Hepatobiliary Surgeons Treat?

Hepatobiliary surgeons treat cancerous and noncancerous diseases of the liver, pancreas, bile ducts and gallbladder. These may include primary or metastatic liver tumors, pancreatic tumors and cysts, bile duct or gallbladder cancers, benign liver growths and complex disorders such as bile duct strictures or injuries.

Because these conditions can look similar on imaging but require very different treatment, the surgeon’s role often begins with clarifying the diagnosis and identifying which options are appropriate.

Some patients may benefit from an operation, while others are better served by monitoring, medication or a nonsurgical procedure.

Why is it Important to Have a Surgeon Who Specializes in Hepatobiliary Conditions?

The liver, pancreas and bile ducts sit within a compact area of the abdomen and share critical blood vessels and drainage pathways. A disease or operation involving one organ can therefore affect several surrounding structures.

For example, liver surgery must remove diseased tissue while preserving enough healthy liver to function. Bile duct surgery may require rebuilding the pathway that carries bile from the liver, while pancreatic surgery can involve the small intestine, gallbladder and nearby blood vessels.

Specialized experience helps the surgeon anticipate these connections, determine whether an operation can be performed safely and choose an approach that balances disease removal with preservation of organ function.

What types of hepatobiliary conditions can be treated with surgery?

When surgery is appropriate, the procedure is selected based on the organ involved and the extent of disease. Options may include removing the gallbladder, part of the liver or a segment of the bile duct, sometimes followed by reconstruction to restore normal drainage.

One of the most complex procedures is the Whipple procedure, or pancreaticoduodenectomy, most often used for tumors in the head of the pancreas and selected tumors involving nearby structures. The surgeon removes the head of the pancreas, the first part of the small intestine, the gallbladder and part of the bile duct, 
then reconnects the digestive system so food and digestive fluids can continue to move through it.

At MemorialCare Todd Cancer Institute at Long Beach Medical Center, we offer advanced procedures such as Whipple surgery, allowing patients to receive this complex care close to home. With fellowship training in hepato-pancreato-biliary surgery, we can offer the Whipple procedure when it is the right option for a patient.

Robotic surgery is also available for patients with certain liver, pancreas, bile duct and gallbladder conditions. Using a robotic system, the surgeon operates through a few small incisions with a magnified, 3D view and highly precise instruments. Compared with traditional open surgery, this minimally invasive approach may mean less pain, a shorter hospital stay and a quicker return to daily activities. Whether robotic surgery is the right option depends on the condition, the location and extent of disease, and the patient’s overall health.

When Should Someone be Referred to a Hepatobiliary Surgeon?

A consultation is appropriate when imaging or testing identifies a suspicious finding in the liver, pancreas, gallbladder or bile ducts, or when a complex problem may require surgical input. Referral may come from a gastroenterologist, oncologist, primary care physician or another specialist.

Early involvement is especially valuable because the timing and sequence of treatment can affect future surgical options. A hepatobiliary surgeon can help the care team plan with that possibility in mind, even if another treatment comes first.

If I Am Referred to a Hepatobiliary Surgeon, Does That Mean I Need Surgery?

No. A referral is an opportunity to obtain a specialist’s assessment, not a commitment to have a surgery.

During the consultation, the surgeon reviews the diagnosis, explains whether surgery could be beneficial and discusses how it compares with other treatment options.

For some patients, chemotherapy, radiation therapy, advanced endoscopy or interventional radiology may be recommended before surgery is reconsidered, or instead of an operation.

How Do You Determine Whether a Tumor Can Be Surgically Removed?

Determining whether a tumor can be removed requires more than measuring its size. The surgeon studies its location, relationship to major blood vessels and nearby organs, whether it has spread, and whether enough healthy tissue can remain after surgery.

In liver surgery, for example, removing the visible tumor is only one goal; the team must also calculate whether the remaining liver will be sufficient to support recovery and long-term function.

This detailed review can reveal options that may not be apparent from a single scan or test and supports an individualized recommendation.

How Does Hepatobiliary Surgery Fit Into Multidisciplinary Cancer Care?

At MemorialCare Todd Cancer Institute at Long Beach Medical Center, hepatobiliary cases are reviewed with specialists in medical oncology, gastroenterology, advanced endoscopy, interventional radiology, radiation oncology, radiology and pathology.

That collaboration takes place through a multidisciplinary Tumor Board, where the team reviews the patient’s medical history, imaging and biopsy results to reach a consensus on an individualized plan, including the timing and sequence of care. A surgical referral does not mean an operation is immediate or inevitable; another therapy, further testing or monitoring may be the most appropriate next step.

Through this process, the team can compare surgical and nonsurgical options, resolve questions about the diagnosis and agree on the order of treatment rather than asking patients to navigate separate recommendations on their own.

That level of collaboration is an important differentiator for patients with complex disease: advanced surgical expertise and the supporting specialties needed before, during and after treatment are available within one coordinated program.

What Should Patients Know After Receiving a Complex Hepatobiliary Diagnosis?

Patients do not need to understand every option immediately. A useful first step is to gather available imaging and test results and seek an evaluation from a team experienced in these uncommon and complex diseases.

That evaluation can clarify the diagnosis, identify the specialists who should be involved and provide a plan for what happens next—whether that means monitoring, another treatment or surgery.

If you have a condition affecting the liver, pancreas, bile ducts or gallbladder, we’re here to help. Call (877) 944-9162 to schedule a consultation with our hepatobiliary experts at MemorialCare Todd Cancer Institute at Long Beach Medical Center to understand your options and find the right treatment for you.

Medically Reviewed By:

Au Bui, M.D., hepatobiliary surgeon, MemorialCare Todd Cancer Institute, Long Beach Medical Center

About the Expert:

Au Bui, M.D., is a board-certified, fellowship-trained surgeon specializing in gastrointestinal, liver, bile duct, pancreatic and gallbladder diseases at MemorialCare Todd Cancer Institute at Long Beach Medical Center. His clinical interests include minimally invasive techniques, such as laparoscopic and robotic surgery, to treat complex gastrointestinal and hepatobiliary conditions.