The Hepatobiliary Rotation

December 18, 2013   

I interned at the Hepatobiliary department for two weeks. I was able to see a lot of operations with more technical precision that requires patience and skill. The doctors in the department were all good to us; we were able to attend more than three surgeries everyday. The Hepatobiliary department doctors are divided into four groups – each group consists of 1 professor, 2 associate professors, 3 to 4 attending doctors, 2 residents and one student. Each group performs one or two operations everyday. Luckily, I was able to work with one of the best professors in the Hepatobiliary department.

First Week

The first day was all prefatory, we didn’t attend any surgery but spent the day talking over with a resident what was required of us. We discussed a few cases we saw in the morning rounds. Most of the cases were gallstones and hemangioma (benign tumor of the liver). We notably saw a patient who had abdominal pain that radiated to the back and thoracic region, the pain was worsened by food and intense exercise. ECG and laboratory test were normal. Nitroglycerin seemed to alleviate the pain. CT scans showed an incidental pancreatic tumor and blockage of all branches of the coronary artery. The patient was transferred to Cardiothoracic department where we had coronary artery bypass graft. He was lucky to be alive.
In the next few days, I was able to attend and see the following procedures; two laparoscopic cholecystectomy – removal of the gallbladder due to gallstones. Partial hepatectomy of left lobe – removal of part of the liver due to hemangioma, and gallstone removal of the biliary tree with ERCP (Endoscopic retrograde cholangiopancreatography).

Second Week

Second week brought more cholecystectomy operations, I lost count of how many I attended because the procedure is safe and takes less than an hour to perform, no blood loss and the recovery period is three days. There was a splenectomy (removal of spleen), both operative and laproscopic. There were partial hepatectomies, due to the tumor and hydatid cysts.
The last day, we did a Whipple operation or procedure which is a major surgical operation that involves the removal gallbladder, common bile duct, antrum of the stomach (distal third of the stomach), entire duodenum, proximal jejunum, and head of the pancreas and reconstruction with pancreaticojejunostomy (connect pancreas with jejunum), choledochojejunostomy ( connect common bile duct with jejunum) and gastrojejunostomy. We also did an ileal resection. The operation took over 10 hours. It was intense and I have never seen a patient lose so much blood in one setting. A major artery was severed and an excellent vascular surgeon was on hand to correct it. The anesthesiologist was on top of everything, be it blood transfusion or rapid infusion of saline and correction of electrolyte abnormalities. One nurse panicked a bit and she was replaced by another one. I have enjoyed watching some of the teachers, especially those who worked together for a long time and had chemistry in the operating room.


I had a valuable experience seeing some common operations that I may be required to perform if I want to be a competent doctor. I also savored working with the attending doctors who made me feel welcome and part of the team, something some doctors don’t afford us since we are foreigners. During mornings, we attended a grand rounds where the doctors discussed the operations for the day; this helped you mentally prepare and may be come up with questions that you may ask during operations or after operation. Next week, I will be interning at the urology department.

Photo is content of the whipple procedure; ileum, pancreatic head with stomach, doudenum and some part of jejunum together.

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