Hepatobiliary surgery covers operations on the liver, the bile ducts, and the gallbladder. These three organs work together to make bile, store it, and deliver it into the small intestine, and the diseases that affect them often overlap.
Dr. Jabbar’s advanced fellowship at AdventHealth Tampa focused on this area, with a concentration on robotic and minimally invasive approaches to liver tumors, bile duct cancers, gallbladder cancer, and complex biliary reconstruction.
This page describes the conditions he treats and the operations he performs, written for patients and families who want to understand what their diagnosis means and what surgery actually involves.
The conditions below are the most common reasons patients are referred to Dr. Jabbar’s practice for hepatobiliary surgery. Each is covered briefly, focusing on the patterns that come up most often in the clinic.
Hepatocellular carcinoma, or HCC, is the most common cancer that starts in the liver itself. It almost always develops in a liver that has been damaged over time. The most common triggers are chronic hepatitis B or C, long-standing alcohol use, and metabolic-associated fatty liver disease (formerly called NAFLD). Cirrhosis from any cause substantially increases the risk.
HCC often produces no symptoms in its early stages. When symptoms appear, they tend to include unexplained weight loss, loss of appetite, upper abdominal discomfort or fullness, and yellowing of the skin and eyes (jaundice). Patients with known cirrhosis are typically screened every six months with an ultrasound and a blood test called alpha-fetoprotein (AFP), because early detection changes what is possible surgically.
Diagnosis usually starts with a multiphase CT or MRI of the liver. In patients with underlying cirrhosis, many HCCs can be diagnosed on imaging alone, without a biopsy, when the lesion shows the classic enhancement pattern.
Treatment depends on the size and number of tumors and on the underlying liver function. Surgical options include liver resection (removing the portion of the liver containing the tumor while leaving enough healthy tissue to function) and liver transplant for patients who meet specific criteria. Non-surgical options include thermal ablation, transarterial chemoembolization (TACE), radioembolization (Y-90), targeted therapy, and immunotherapy. The surgeon’s role is to determine whether the cancer is resectable, usually in collaboration with hepatology and medical oncology.
The liver is the most common site to which colon and rectal cancer spreads. About half of patients with colorectal cancer will develop liver metastases at some point, either at the time of the original diagnosis (synchronous) or later (metachronous). When colorectal liver metastases are limited to the liver and can be completely removed, surgery is the primary treatment offering the best chance for long-term survival.
These metastases usually cause no symptoms on their own. They are typically found on the staging CT scan done at the time of the colorectal cancer diagnosis, or on follow-up imaging during surveillance. A rising CEA level (a tumor marker checked in blood) and elevated liver function tests can also point toward liver involvement.
The treatment plan is built around two questions: can all the disease be removed, and is the rest of the patient’s cancer controlled? If both answers are yes, surgical resection of the liver metastases is often combined with chemotherapy before or after surgery. When the liver that would be left behind is too small for safety, techniques such as portal vein embolization or a two-stage hepatectomy are used to grow the healthy side before removing the diseased side. Ablation can address small lesions that are not safely resectable. Hepatic artery infusion pump chemotherapy is a specialized option used at high-volume centers for borderline disease.
Cholangiocarcinoma is a rare cancer that starts in the thin tubes (the bile ducts) that carry bile from the liver to the small intestine. It is classified by its position along the bile duct tree. Intrahepatic cholangiocarcinoma develops inside the liver. Perihilar or hilar cholangiocarcinoma develops where the right and left ducts join, just outside the liver (also called a Klatskin tumor). Distal or extrahepatic cholangiocarcinoma develops lower in the duct, closer to the small intestine. Each subtype is treated differently.
Symptoms usually reflect the location. Perihilar and distal cholangiocarcinoma frequently present with jaundice, itching, light-colored stools, and dark urine, because the tumor blocks bile drainage. Intrahepatic cholangiocarcinoma is often silent until the tumor is large, and is sometimes found incidentally on imaging done for another reason.
Risk factors include primary sclerosing cholangitis, chronic hepatitis B or C, cirrhosis, choledochal cysts, and liver fluke infection in endemic regions. Many patients have no identified risk factor.
The workup combines CT and MRI with MRCP (a specialized MRI of the bile ducts), tumor markers (CA 19-9, CEA), and tissue sampling through ERCP brushings, percutaneous biopsy, or EUS-guided biopsy.
Surgery is the primary treatment offering the best chance for long-term survival, and the operation depends on the subtype. Intrahepatic cholangiocarcinoma is treated with hepatic resection. Perihilar cholangiocarcinoma often requires an extended hepatectomy combined with bile duct resection and biliary reconstruction (hepaticojejunostomy). Distal cholangiocarcinoma is treated with the Whipple procedure (pancreaticoduodenectomy). Liver transplant, after a specific course of chemoradiation, is an option at select centers for early perihilar disease that cannot be resected. Chemotherapy, radiation, targeted therapy, and immunotherapy all have a role depending on the stage.
Gallbladder cancer is uncommon and frequently diagnosed late, because early symptoms look like ordinary gallstone disease. A significant share of cases are found incidentally, on the pathology report after the gallbladder has been removed for what was thought to be stones.
The most important risk factor is long-standing gallstones, especially in combination with chronic inflammation or large polyps. Other risk factors include porcelain gallbladder (a calcified gallbladder wall), female sex, increasing age, obesity, type 2 diabetes, primary sclerosing cholangitis, and certain ethnic backgrounds.
Symptoms, when present, include right upper quadrant pain, bloating, weight loss, nausea, vomiting, and jaundice. A palpable mass in the upper abdomen is a late finding.
Initial workup includes abdominal ultrasound, multiphase CT, MRI with MRCP, and tumor markers (CA 19-9, CEA). A staging laparoscopy is often performed before a planned resection to look for peritoneal disease that imaging cannot detect.
Cancer that has not invaded the muscle layer (T1a) has an excellent prognosis and is often effectively treated by simple cholecystectomy. Anything deeper requires a radical (extended) cholecystectomy, which involves removing the gallbladder, a wedge of liver tissue from the gallbladder bed, and the regional lymph nodes, often with bile duct resection and reconstruction. Chemotherapy, radiation, and targeted therapy are used depending on stage and pathology.
Cancers from other organs can also spread to the liver. The cancers that most often produce surgically treatable liver metastases include neuroendocrine tumors, breast cancer, ocular and cutaneous melanoma, sarcoma, and renal cell carcinoma. Whether surgery is the right move depends on the type of original cancer, how aggressive its biology is, whether the primary is controlled, and the timing.
Symptoms are usually absent, and the metastases are found on staging imaging or follow-up scans. Some neuroendocrine liver metastases cause carcinoid syndrome (flushing and diarrhea) because of the hormones the tumors release.
Workup includes contrast-enhanced CT or MRI of the liver, PET/CT for selected tumor types, specialized scans such as Ga-68 DOTATATE for neuroendocrine disease, and image-guided biopsy when the origin or treatment plan requires confirmation.
The treatment decision is usually made in a multidisciplinary tumor board, because the right answer depends on the primary cancer. Surgical options include hepatic resection, ablation, and surgical debulking for symptom control. For neuroendocrine liver metastases, resection has the strongest track record of long-term survival among the non-colorectal primaries. Catheter-based treatments such as TACE and radioembolization (Y-90) are used when surgery is not the right fit. Systemic therapy is tailored to the original cancer type.
Not every mass found in the liver is cancer. The three most common benign liver tumors are hepatic hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma. Most are discovered incidentally on imaging performed for another reason, and most do not require surgery.
A hemangioma is a tangle of abnormal blood vessels. It is the most common benign liver tumor and is usually asymptomatic. Larger hemangiomas can cause right upper quadrant pain, early fullness with meals, or nausea, and a small fraction warrant surgical removal.
FNH is a benign overgrowth of normal liver cells around a central scar, thought to develop as a response to abnormal blood flow. It is more common in women of reproductive age. FNH almost never causes symptoms and almost never requires treatment.
Hepatocellular adenoma is less common but more clinically significant. Adenomas are strongly linked to estrogen exposure (oral contraceptives, pregnancy) and to obesity and metabolic syndrome. The concern with adenomas is two-fold: they can bleed, sometimes catastrophically, when they grow above about 5 centimeters, and certain genetic subtypes can transform into HCC. Adenomas larger than 5 centimeters, those with concerning genetic features, those in male patients, and those that have already bled are typically removed surgically. Smaller adenomas are often observed, and stopping oral contraceptives or losing weight can shrink some of them.
Much of the work in the clinic for these conditions involves distinguishing a benign lesion from a true malignancy. Specialized contrast MRI is the most useful test for that distinction, and biopsy is reserved for cases that cannot be characterized on imaging alone.
Gallstones are hardened deposits, usually of cholesterol or bilirubin, that form inside the gallbladder. Many people with gallstones have no symptoms and never will. The classic symptomatic presentation is sudden, severe pain in the upper right abdomen or just below the breastbone, often after a fatty meal, sometimes radiating to the right shoulder blade. Episodes can last minutes to hours and are often accompanied by nausea or vomiting.
Cholecystitis occurs when a stone blocks the cystic duct, the small tube that drains the gallbladder. Bile builds up and the gallbladder wall becomes inflamed; bacterial infection may occur but is not present in every case. Patients present with persistent, severe right upper quadrant pain, fever, chills, and tenderness over the gallbladder. If a stone migrates further down the bile duct, it can cause jaundice, pancreatitis (gallstone pancreatitis), or a more serious infection called cholangitis.
Diagnosis starts with an abdominal ultrasound, which is highly effective at detecting stones. A HIDA scan can confirm cholecystitis when an ultrasound is unclear. CT and MRCP are added to look for complications. Lab work includes a white blood cell count, liver enzymes, bilirubin, and lipase.
Asymptomatic gallstones do not need surgery. Symptomatic gallstones and cholecystitis are treated with cholecystectomy, the surgical removal of the gallbladder. This is almost always done laparoscopically or robotically — usually as an outpatient procedure for elective cases, and during the same hospital admission for acute cholecystitis when clinically appropriate. Most patients live normally without a gallbladder, as bile flows directly from the liver into the small intestine. If there are stones in the common bile duct, those are addressed either by ERCP or by surgical bile duct exploration.
The operations below are the most common procedures Dr. Jabbar performs for the conditions described above. Whenever the disease and anatomy allow, they are performed robotically through small incisions. When the case requires it, the same operations are performed open.
A major hepatectomy is the removal of three or more of the liver’s eight anatomic segments. In practice, this is usually a formal right hepatectomy, left hepatectomy, or an extended version of one of those.
The liver is unusual among solid organs in that it regenerates. After a major resection, the remaining liver grows over the following weeks and months, taking over most of the lost function.
Major hepatectomy may be appropriate for large or centrally located HCC, intrahepatic and perihilar cholangiocarcinoma, gallbladder cancer with significant liver bed involvement, and colorectal liver metastases that cannot be addressed with smaller resections. Select large benign tumors are also treated this way.
These operations were historically done open, through a long subcostal or “Mercedes” incision. At experienced centers, robotic and laparoscopic major hepatectomy are now well established. The choice depends on the tumor’s size and location, the surrounding anatomy, whether vascular reconstruction is needed, and the surgeon’s expertise. Intraoperative ultrasound is used in nearly every case to define the resection plane.
Hospital stay generally ranges from four to seven days after open major hepatectomy. Robotic and laparoscopic approaches are reported in the literature to be associated with shorter stays under enhanced recovery protocols. Full recovery is measured in weeks, with the liver itself regenerating over the following months.
Minor liver resection covers operations that remove one or two segments of the liver, or a non-anatomic wedge of liver tissue around a small lesion. The goal is to remove the tumor with a clear margin while preserving as much healthy liver as possible.
Common indications include small HCC, solitary colorectal liver metastases, small intrahepatic cholangiocarcinoma, large or atypical benign tumors that warrant removal, and diagnostic resection of lesions that cannot be characterized on imaging.
Minor resection is among the strongest indications for a robotic or laparoscopic approach, especially when the lesion sits in the anterior or lateral segments. Open surgery is generally reserved for posterior or superior locations, large lesions, or fields scarred by prior abdominal surgery. Intraoperative ultrasound guides margin selection.
Recovery is faster than for major resection. Hospital stay is often one to three days after a laparoscopic or robotic minor resection and three to five days after an open resection.
A central hepatectomy is an anatomic resection of the central liver segments (4, 5, and 8, sometimes with segment 1) while preserving the left lateral and right posterior portions of the liver. It is a technically demanding alternative to an extended right or left hepatectomy, designed to remove a central tumor without sacrificing more liver than necessary.
The most common reason to choose central hepatectomy over a larger resection is limited liver reserve. Patients with cirrhosis or marginal liver function may not tolerate an extended hepatectomy, and removing only the central portion can spare enough functioning liver to recover.
Indications include centrally located HCC, cholangiocarcinoma, gallbladder cancer extending into the liver bed, and large benign tumors in segments 4, 5, or 8.
The operation requires two transection planes, careful exposure of the middle hepatic vein, and work close to all of the liver’s major inflow and outflow structures. It is most often performed open at present, with robotic central hepatectomy performed at high-volume centers. Hospital stay tends to be longer than for a peripheral resection, and bile leak from the two raw liver surfaces is the most common complication.
Ablation is a non-resectional way of destroying a liver tumor in place. A needle-like probe is passed into the tumor and used to generate heat that kills the tumor cells. Radiofrequency ablation (RFA) uses alternating electrical current; microwave ablation (MWA) uses electromagnetic energy. MWA generally produces a larger and more uniform ablation zone and is increasingly preferred for tumors near major vessels.
Ablation may be used for selected small primary or metastatic liver tumors as an alternative to resection, as a bridge to transplant, or in combination with surgery, depending on tumor biology, location, liver function, and multidisciplinary review. It is also used as a bridge to liver transplant, in combination with resection for multifocal disease, and for small liver metastases that cannot be removed safely.
The procedure is most often done percutaneously (through the skin) under CT or ultrasound guidance, often by interventional radiology. Laparoscopic and open ablation are used when the tumor location requires it or when ablation is combined with another operation. Percutaneous ablation is frequently an outpatient or overnight procedure.
Cholecystectomy is the surgical removal of the gallbladder. Once the gallbladder is gone, bile flows directly from the liver into the small intestine, and most patients live normally without it.
The most common reasons for cholecystectomy are symptomatic gallstones, acute or chronic cholecystitis, biliary dyskinesia, gallstone pancreatitis, large gallbladder polyps, and early gallbladder cancer found incidentally. Cholecystectomy is one of the most frequently performed abdominal operations in the United States.
The standard approach today is laparoscopic, through four small abdominal incisions. Robotic cholecystectomy is used at many centers, particularly for difficult anatomy or single-incision approaches. Open cholecystectomy is reserved for severe inflammation, dense adhesions from prior surgery, complex anatomy, suspected malignancy, or conversion from laparoscopy when the anatomy makes minimally invasive surgery unsafe.
Elective laparoscopic cholecystectomy is usually performed as an outpatient or same-day procedure. Patients having surgery for acute cholecystitis are generally hospitalized for one to two days. Return to normal activity typically takes about one to two weeks.
A radical (extended) cholecystectomy is the cancer operation for gallbladder cancer that has invaded beyond the inner lining of the gallbladder. It removes the gallbladder, a wedge of liver tissue from the gallbladder bed (often segments 4b and 5), and the regional lymph nodes along the hepatoduodenal ligament and porta hepatis. The bile duct is sometimes resected and reconstructed.
There are two main scenarios where radical cholecystectomy is indicated. The first is when gallbladder cancer is suspected before surgery, based on imaging and tumor markers. The second is when gallbladder cancer is found incidentally on the pathology report after a simple cholecystectomy for presumed benign disease, and the depth of invasion is T1b or greater. In that situation, a planned re-resection is generally recommended.
The operation has traditionally been done open, through a right subcostal incision. Laparoscopic and robotic radical cholecystectomies are performed at experienced centers, with comparable oncologic outcomes reported in selected cases. Staging laparoscopy is often performed first to look for peritoneal spread that cannot be seen on imaging.
Hospital stay generally ranges from three to seven days, depending on the approach.
Biliary reconstruction is the operation that creates a new pathway for bile to flow from the liver into the gut when the original bile duct cannot be used. The most common version is called a Roux-en-Y hepaticojejunostomy: a limb of the small intestine (jejunum) is brought up to the bile duct and sewn directly to it, bypassing the original drainage route. The long Roux limb prevents intestinal contents from refluxing into the bile ducts.
Reconstruction is needed in several situations. Bile duct injury, most often during a difficult laparoscopic cholecystectomy, is one of the most common reasons. Benign bile duct strictures, choledochal cysts (congenital cystic dilations of the bile duct), selected refractory strictures in primary sclerosing cholangitis and bile duct reconstruction during liver transplantation may require hepaticojejunostomy; endoscopic management is generally preferred first for relevant PSC strictures. It is a standard part of the Whipple procedure for pancreatic and distal bile duct cancer, and it is the reconstruction performed after bile duct resection for perihilar cholangiocarcinoma or gallbladder cancer.
The operation is most commonly done open, though laparoscopic and robotic hepaticojejunostomy are performed at high-volume centers. Recovery depends on whether the reconstruction is the entire operation or part of a larger resection.
Common bile duct exploration is the surgical removal of stones from the common bile duct, the main tube that carries bile from the liver and gallbladder into the small intestine. It is often combined with cholecystectomy when stones are found in both the gallbladder and the bile duct.
The decision to explore the duct surgically, rather than treating it endoscopically with ERCP, depends on the situation. ERCP and laparoscopic bile duct exploration are both accepted options for bile duct stones; the sequence depends on local expertise, timing, anatomy, and whether cholecystectomy is already planned. Patients who have had certain prior surgeries (for example, gastric bypass) cannot have a standard ERCP. In those cases, and when stones are discovered during a planned cholecystectomy, surgical exploration is the answer.
The modern approach is laparoscopic, often through the cystic duct itself (transcystic), using a thin choledochoscope and a stone basket. When the stones are too large or numerous for transcystic clearance, the bile duct is opened directly (choledochotomy) and the stones are removed under direct vision. Open exploration is used in complex cases or when minimally invasive techniques are not appropriate. Robotic common bile duct exploration is increasingly available.
Hospital stay is typically one to three days for transcystic exploration, and longer when a T-tube is placed in the duct.
