Department of Surgery

Hepatobiliary and Liver Transplantation

Dr. Rick Selby, a transplant surgeon recruited in 1995 to establish a liver transplant program at USC, heads the division of Hepatobiliary/Pancreatic and Liver Transplantation. Dr. Nicolas Jabbour and Dr. Steven Stain are the other staff members along with an assistant Unit Chief (AUC) at the LA County Medical Center. The staff covers USC University Hospital, LAC + USC Medical Center, and Norris Cancer Center.

At LAC + USC Medical Center, the hepatobiliary/pancreatic surgery service is part of the subspecialty services that have been established since July 1997. It focuses on disease of the pancreas, liver, and biliary system. The staff members, chief resident, and an intern in general surgery run the service. Most of the patients are admitted after being screened by non-trauma emergency services or through direct admission from the outpatient clinic.

The pathology seen by this division is divided into pancreatic, biliary, and liver. The pancreatic disease patients are those with acute pancreatitis with different severities, chronic pancreatitis, benign and malignant pancreatic tumor, and complication of acute pancreatitis such as pseudocyst, pancreatic abscess, and chronic pancreatitis.

Patients with liver disease include those with benign liver tumors such as adenoma, focal nodular hyperplasia, hemangioma, or liver abscesses, patients with malignant liver tumor (hepatoma metastatic liver disease), and those with end-stage liver disease for workup for liver transplantation, or who require surgical shunt for variceal bleeding.

Biliary tract pathology include mainly complicated biliary disease such as multiple common bile duct stones, benign or malignant biliary stricture, laparoscopic bile duct injury, and recurrent cholangiohepatitis with multiple intrahepatic stones.

The service at the Medical Center is structured in a way to offer the surgical residents an in depth experience from the academic, the operative, and the outpatient aspects of management.

The services of the hepatobiliary and pancreatic division, both at LAC +USC and University Hospital, although are separate, are run by the same staff, and are complementary for the residents. After the completion of both rotations, the residents will have a deep understanding of the management and treatment of patients with pancreatitis, liver, or complicated biliary disease.

The weekly academic activities include the following:

  • Monday 12:30 p.m.
    Liver Conference by Telfer Reynolds, M.D.
    This interdisciplinary conference covers patients with medical/surgical pathology of the liver.
  • Monday 4:30 p.m.
    Pancreas Conference by Rick Selby, M.D., Russell Yang, M.D. and Dilip Parekh, M.D.
    This is a combined GI/hepatobiliary surgery conference that covers patients with different pathology of the pancreas.
  • Tuesday 8:30 - 11:30 a.m.
    Staff Rounds
    Includes both residents and staff and offer productive exchange to the residents regarding the patients on the service. Part of the staff rounds includes radiology round, where both pre and postoperative radiology studies are reviewed by radiology staff. On a monthly basis, staff rounds also include tumor board that covers the pathology of all benign and malignant tumors that are removed during surgical procedures.
  • Friday 12:00 noon
    GI Conference
    This is a combined surgical and medical conference with case presentation and literature reviews focused on upper and lower GI, pancreas, liver, and biliary tract.

Operative Experience

Operative time for the hepatobiliary and pancreatic service at LA County is Monday, Wednesday, and Thursday. All cases are performed by the residents on the service with staff present at all times, either in the operating room or scrubbed during these cases.

During each rotation, the chief resident would have the chance to participate and perform several surgeries on the pancreas from pancreatic debridement to pancreatic resection for malignant or benign pathology, liver resection, and major biliary reconstruction.

The outpatient exposure is acquired at the LA County Clinic that is run on Friday afternoon from 1 - 5 p.m. The clinic includes both patients who require workup for hepatobiliary or pancreatic surgery as well as follow up of patients who were previously operated on.

At the USC University Hospital and the Norris Cancer Center, the hepatobiliary and pancreatic division is part of the Gold team that also includes the vascular surgery division. Three surgery residents, PGYIV, PGYII, and PGYI run the service. The residents will be exposed to patients similar to those at the LA County facility, in addition to liver transplantation. This service will focus more on the basic knowledge of the liver pathology to allow the residents to acquire an interpretation of liver function test and the understanding of, manifestation, and therapy of patients with end-stage liver disease. They also will have a chance to participate in liver harvesting and liver transplantation procedures. The post operative care of these patients will allow the residents to acquire basic experience in the management of patients with immunosuppression.

From the academic point of view, the residents will have the opportunity to participate in the Liver Candidate Conference on Wednesday, 5:30 p.m., and the Liver Conference on Thursday, 7:30 a.m. Both of these conferences are multidisciplinary that include pathologist, radiologist, hepatologist, and surgeons. Its focus is on patients with various liver pathologies both surgical and medical.

Beside daily staff rounds, formal medical/surgical grand round is conducted on Thursday, 9:00 a.m. This will offer the residents an exposure to both the medical and surgical aspect of patients with liver disease. The operative time is usually Friday, for elective cases, and anytime for liver transplantation. Over the last year, each surgical resident rotating on this service had experience with at least one organ recovery procedure, one liver transplantation, and many cases of liver or pancreatic resection.

From the research point of view, the service is conducting at any time several clinical research projects that cover pancreatic, liver, and biliary pathology. These projects are done by the residents rotating on the service, under the supervision of a staff member. Each year, an average of three papers are published from the division of hepatobiliary and pancreatic surgery.

The services of the hepatobiliary and pancreatic division, both at LA County and University Hospital, although are separate, are run by the same staff, and are complementary for the residents. After the completion of both rotations, the residents will have a deep understanding of the management and treatment of patients with pancreatitis, liver, or complicated biliary disease.

University of Southern California University of Southern California