Actuality - Hepato-pancreato-biliary (HPB) surgery and abdominal organ transplantation, a defined subspecialty, integrated within the surgical division: Professional, operative and educational aspects

Introduction: Establishment of hepato-pancreato-biliary (HPB) surgery and abdominal organ transplantation as defined subspecialties of general surgery has been boosted over the last decade. However, the affiliation (independent service vs. integration within the division of surgery), the training course (transplantation vs. surgical oncology) and the referral patterns are still controversial. Methods: Dedicated HPB and transplantation units were defined within the surgical division of the Tel Aviv Medical Center. The principles of operation included multidisciplinary expert teams, unified and standard treatment protocols, exposure and involvement of all residents and attending surgeons of the division to patients, decision-making and perioperative care, peer review and periodic publication of clinical results. Results: Between the years 2003-2007, 870 major HPB procedures were performed: 70 liver transplants (9 from live donors), 100 organ procurements, 165 kidney and kidney-pancreas transplants (30% from live donors), 250 hepatic resections of various types and indications, 35 complex biliary reconstructions and 250 pancreatectomies. The short- (morbidity and mortality) and long-term (survival and disease free survival) rates are compatible with the reported results from Centers of Excellence around the world. Conclusions: Operating HPB and transplantation surgery by trained experts and defined professional units, but within an academic surgical division, promotes the achievement of high volume and excellent results together with optimal exposure, education and training of the surgical residents.