The Leicester HPB Unit | Overview

About Us Title Image

Clinical Work

The work of the unit can be divided into 5 main streams comprising of:

  • Endoscopic Work (ERCP & EUS)

  • Cancer & Major Resections

  • Major Complex Biliary Work

  • Laparoscopic Cholecystectomy & Day case Procedures

  • National specialist services including supra-regional services such total pancreatectomy and autologous islet cell transplantation

Endoscopic Work (ERCP & EUS)

 

The unit undertakes over 1,000 ERCPs annually with about one third of cases coming from external hospital providers.

Figure 1: Numbers of ERCPs undertaken between 2012 and 2013

Leicester is unique in providing such an integrated service where surgeons undertake the majority of the ERCP procedures and also provide (see later pages) the majority of cholecystectomies. This affords an unprecedented opportunity to promptly treat jaundice and allows for a simultaneous assessment by a surgeon to determine suitability for cholecystectomy (if benign disease) or major resection if malignant. The unit has set up a formalised EUS-referral form for both internal referrals and “out of area” referrals. 

 

Cancer & Major Resections

 

HPB is one of the busiest tumour sites in the UHL discussing over 1,500 cancer cases annually. The unit has seen a steady increase in the number of cases referred since 2001 

Figure 2: Suspected and Confirmed Cancer Referrals to the HPB MDT

The unit has a catchment area of over 2.5 million and receives referrals from a wide range of other
hospital providers in the East Midlands and East Anglia. The unit undertakes over 80 pancreatic resections and 130 liver resections annually. Mortality for both procedures is less than 1%.

 

Major Complex Biliary Work

 

In addition, to major cancer resections Leicester provides an invaluable service to the surrounding district such as management of severe acute pancreatitis, repair of bile duct injuries, laparoscopic bile duct exploration and bile duct reconstructions. These operations form about 30% of the unit’s workload. Leicester has Europe’s largest (and at one point the World’s largest) total pancreatectomy and autologous islet transplantation programme. Leicester had undertaken 65 of the procedures for chronic pancreatitis thus far, with excellent results.

 

Laparoscopic Cholecystectomy

 

Laparoscopic cholecystectomy is undertaken for gallstone related pain and/or complications which have arisen from gallstones such as acute pancreatitis or jaundice. To a lesser extent this procedure is also undertaken for premalignant gallbladder conditions such as polyps. Over 95% of the laparoscopic cholecystectomies undertaken in Leicester are performed by the HPB unit (90%)

Figure 3: Breakdown of elective procedures undertaken by GI Surgery from 2012 to 2013

 

Summary

 

The HPB unit is an extremely busy and thriving department which has been expanding year on year. It undertakes a wide range of complex endoscopic procedure, day case laparoscopic surgery and major cancer resections