HPB stands for hepato-pancreato-biliary, a medical term that refers to the liver, pancreas, gallbladder, and bile ducts as a connected organ system. You’ll most often see it used in the context of HPB surgery or HPB medicine, which is the specialty focused on diagnosing and treating diseases affecting these organs. If your doctor has mentioned an “HPB specialist” or an “HPB referral,” it means they want someone with advanced training in this specific group of organs to evaluate your condition.
The Organs HPB Covers
The three parts of the term map directly to the organs involved. “Hepato” refers to the liver. “Pancreato” refers to the pancreas. “Biliary” refers to the biliary system, which includes the gallbladder and the network of ducts that transport bile.
These organs work closely together. The liver produces bile, which is collected through the right and left hepatic ducts and flows into the common hepatic duct. That duct joins with the cystic duct from the gallbladder to form the common bile duct, which delivers bile to the first section of the small intestine. About 50% of the bile the liver produces gets stored in the gallbladder before being released. The pancreas, meanwhile, shares a drainage pathway with the bile ducts, which is why diseases in one organ frequently affect the others.
Because these structures are so interconnected, a problem in one area often creates symptoms or complications in another. A tumor at the head of the pancreas, for instance, can block the bile duct and cause jaundice. Gallstones can migrate into the common bile duct and trigger inflammation in the pancreas. This overlap is exactly why HPB exists as its own specialty rather than splitting these organs across unrelated departments.
Conditions Treated by HPB Specialists
HPB specialists handle both cancerous and non-cancerous conditions. On the cancer side, the most common include liver cancer (hepatocellular carcinoma), pancreatic cancer, gallbladder cancer, bile duct cancer, and cancers that have spread to the liver from other organs. On the non-cancerous side, they treat gallstones, pancreatitis, liver cysts, pancreatic cysts, and bile duct injuries.
Gallbladder-related problems are among the most frequent reasons people encounter HPB care. Acute gallbladder inflammation typically shows up as persistent pain in the right upper abdomen, often with nausea or vomiting after eating fatty foods. Jaundice, a yellowing of the skin and eyes, is another common symptom that triggers an HPB evaluation. It can signal anything from a simple gallstone blocking a duct to a more serious condition like bile duct or pancreatic cancer, so doctors treat it with a high level of suspicion.
Infection of the bile ducts, called cholangitis, can range from mild symptoms to life-threatening septic shock. The classic combination of jaundice, fever, and right-upper-quadrant pain is highly specific for this diagnosis but only appears in about 18.5% of patients, which means many cases present with vague, nonspecific symptoms that require a trained eye to identify.
How HPB Problems Are Diagnosed
Two specialized imaging tools are central to HPB diagnosis. The first is MRCP (magnetic resonance cholangiopancreatography), a non-invasive MRI-based scan that produces detailed 3D images of the bile ducts and pancreatic ducts without radiation or sedation. It works by highlighting the fluid inside these ducts, making blockages, stones, or narrowing easy to spot.
The second is ERCP (endoscopic retrograde cholangiopancreatography), which remains the gold standard for evaluating the biliary and pancreatic region. ERCP combines an endoscope (a thin, flexible tube passed through the mouth) with X-ray imaging and has a major advantage: it can treat problems during the same procedure, such as removing a stuck gallstone or placing a stent in a blocked duct. The tradeoff is that ERCP is invasive, requires sedation, and carries a complication rate of 1% to 7%, including risks of bleeding, infection, and pancreatitis. For this reason, ERCP is now used almost exclusively when treatment is planned, while MRCP handles the initial diagnostic imaging.
For cancer evaluation, enhanced MRI with a contrast agent has shown accuracy rates of 81% to 83% in guiding treatment decisions for liver cancer, significantly outperforming CT scans (which hit 70% to 73%) and excelling at detecting small or satellite tumors that CT might miss.
Common HPB Surgical Procedures
The types of surgery performed under the HPB umbrella range from relatively straightforward gallbladder removal to some of the most complex operations in all of surgery.
Liver resection (hepatectomy) involves removing part of the liver to treat tumors. Minor resections remove a small segment or wedge of tissue around a tumor, while major resections remove more than three of the liver’s eight segments. When multiple tumors are present, surgeons may combine resection with ablation (destroying tumors with heat or cold) or perform the operation in two stages, giving the liver time to regenerate between procedures. Because the liver is one of the few organs that can regrow, patients can sometimes have a significant portion removed and still recover full function. Liver resection is also performed on healthy donors who give part of their liver for transplant.
The Whipple procedure (pancreaticoduodenectomy) is one of the most well-known HPB operations. It involves removing the head of the pancreas, the first part of the small intestine, the gallbladder, and the bile duct, then reconnecting the remaining organs so food can still move through the digestive system. It is the primary surgical option for pancreatic cancer that hasn’t spread beyond the pancreas and can also treat pancreatic cysts, other pancreatic tumors, and chronic pancreatitis.
Who HPB Surgeons Are
HPB surgery is a subspecialty that requires years of training beyond a general surgery residency. There is no single global pathway, but the common thread is that meaningful HPB training happens at the very end of surgical education, typically through dedicated fellowships.
In North America, surgeons can pursue HPB training through Fellowship Council-approved programs certified by the Americas HPB Association, transplant surgery fellowships that combine liver transplant with HPB surgery, or complex general surgical oncology fellowships. In Japan, the process involves three progressive levels of board certification, culminating in a requirement to complete 50 major HPB cases, submit surgical videos, and demonstrate ongoing academic contributions. Australia and New Zealand run a competitive two-year fellowship with entry and exit requirements that include minimum caseloads and exams.
This level of specialization matters because HPB surgery involves organs with complex blood supply and shared drainage systems, where small errors carry serious consequences. The International Hepato-Pancreato-Biliary Association (IHPBA) sets global practice standards and publishes consensus guidelines for conditions like gallbladder cancer, helping ensure consistent care across countries.
The Multidisciplinary HPB Team
HPB care rarely involves a single doctor working alone. Complex cases, particularly cancers, are managed by a multidisciplinary team that typically includes HPB surgeons, medical oncologists, interventional radiologists, diagnostic radiologists, pathologists, radiation oncologists, and liver specialists. These teams meet regularly to review individual cases and develop treatment plans that account for every angle.
This approach matters because different specialists naturally favor the treatments they know best. An interventional radiologist might lean toward a catheter-based treatment for a liver tumor, while a surgeon might prefer resection. The team format forces these perspectives into dialogue, preventing any single-specialty bias from driving the plan. For advanced liver cancer, the team might combine a medical oncologist’s systemic therapy with targeted local treatments like ablation for residual tumors or focused radiation for clots in the portal vein. The HPB surgeon specifically leads decisions about curative-intent treatments like surgical resection and liver transplantation for early-stage, resectable cancers.