E-AHPBA - HPB Insights

The management of chronic pancreatitis remains challenging, and while advances in endoscopy, imaging, and surgery have improved outcomes, it is harsh testimony that a total pancreatectomy, the earliest operation performed for CP back in 1946, is still a treatment option for a benign disease that was identified on autopsy more than 200 years ago.
Today we are joined by Professor Ajith Siriwardena, head of HPB at Manchester University, Past President of the E-AHPBA and internationally recognised for his work in pancreatic surgery and chronic pancreatitis. We will discuss practical decision-making in chronic pancreatitis,  from medical therapy and pain management through to complex resections.
Guest Bio: 
Professor Ajith Siriwardena is a Professor of HPB Surgery at the University of Manchester and Consultant Hepatobiliary and General Surgeon at Manchester Royal Infirmary.
Following training in Manchester and Edinburgh, he undertook advanced liver surgery training in Paris, and subsequently worked in Scotland’s national liver surgery unit before taking up his consultant position in Manchester in 1999. He has built an extensive academic and clinical career in HPB oncology, with particular expertise in liver and pancreatic surgery and colorectal liver metastases, alongside a substantial body of research spanning liver and pancreatic disease.
He was appointed Professor of HPB Surgery at the University of Manchester in 2008 and was recognised with the Silver Scalpel award for surgical training in 2007. His career has also included significant contributions to surgical research, education and international HPB collaboration, and he currently serves as Past President of the E-AHPBA.
References:
Braganza J, Lee S, McCloy R et al. Chronic pancreatitis, The Lancet, 2011; 377, 1184-1197
Siriwardena AK, Mason JM, Balachandra S, Bagul A, Galloway S, Formela L, Hardman JG, Jamdar S. Randomised, double blind, placebo controlled trial of intravenous antioxidant (n-acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis. Gut. 2007 Oct;56(10):1439-44. doi: 10.1136/gut.2006.115873. Epub 2007 Mar 13. PMID: 17356040; PMCID: PMC2000286.
Bhardwaj P, Garg PK, Maulik SK, Saraya A, Tandon RK, Acharya SK. A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis. Gastroenterology. 2009 Jan;136(1):149-159.e2. doi: 10.1053/j.gastro.2008.09.028. Epub 2008 Sep 25. PMID: 18952082.
Siriwardena AK, Windsor J, Zyromski N, Marchegiani G, Radenkovic D, Morgan C, Passas I, Olah A, Conlon KC, Smith M, Busch O, Baltatzis M, Besselink MG, Vollmer C, Castillo CF, Friess H, Garcea G, Burmeister S, Hackert T, Lillemoe KD, Schulick R, Shrikhande SV, Smith A, Gianotti L, Falconi M, Adams D, Adham M, Andersson R, Del Chiaro M, Devar J, Jegatheeswaran S, van Santvoort H, Khatkov I, Izbicki J, Büchler M, Neoptolemos JP, Bassi C, Dervenis C. Standards for reporting on surgery for chronic pancreatitis: a report from the International Study Group for Pancreatic Surgery (ISGPS). Surgery. 2020 Jul;168(1):101-105. doi: 10.1016/j.surg.2020.02.007. Epub 2020 Mar 14. PMID: 32183994.
van Veldhuisen CL, Kempeneers MA, de Rijk FEM, et al. Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis: Follow-Up Analysis of the ESCAPE Randomized Clinical Trial. JAMA Surg. 2025;160(2):126–133. doi:10.1001/jamasurg.2024.5182
Di Sebastiano P, di Mola FF, Buchler MW, Friess H. Pathogenesis of pain in chronic pancreatitis. Dig Dis. 2004;22(3):267-72. doi: 10.1159/000082798. PMID: 15753609.
Izbicki JR, Bloechle C, Broering DC, Kuechler T, Broelsch CE. Longitudinal V-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure. Ann Surg. 1998 Feb;227(2):213-9. doi: 10.1097/00000658-199802000-00010. PMID: 9488519; PMCID: PMC1191238.

During this episode we turn our focus to one of the more demanding aspects of pancreatic surgery: vascular reconstructions and intra-operative emergencies. These are moments that test not only technical ability, but judgement, preparation, and teamwork. Knowing when and how to perform vascular reconstruction - and how to respond when things don’t go to plan, can be the difference between success and catastrophe. We’re joined by the esteemed Professor Shailesh Shrikhande, former deputy director of Tata Memorial Hospital in Mumbai and past president of the APHPBA. 
 
Episode Breakdown:
00:00 Introduction to episode
05:28 Early influences: Heidelberg
15:59 Vascular reconstruction training
20:52 Navigating the complexities of arterial reconstructions
26:16 Managing vascular emergencies
34:03 Technical challenges in surgery
40:28 SMA first approach
49:48 Closing thoughts and remarks
 
Professor Shailesh Shrikhande is a globally recognised hepatopancreatobiliary (HPB) and gastrointestinal surgical oncologist based in Mumbai, India. He is Professor of Surgical Oncology, Head of the GI and HPB Surgical Service, and Deputy Director at the Tata Memorial Centre, and is the immediate past president of the APHPBA. Internationally renowned for his expertise in complex pancreatic and gastrointestinal cancer surgery, he has trained at the Universities of Heidelberg and Bern, was the first Asian recipient of the IHPBA Kenneth Warren Fellowship, and has authored hundreds of peer-reviewed publications while making significant contributions to global HPB education and training.
 
References:
Shrikhande SV, Kleeff J, Büchler MW, Friess H. Pancreatic anastomosis after pancreaticoduodenectomy: how we do it. Indian J Surg. 2007 Dec;69(6):224-9. doi: 10.1007/s12262-007-0031-3. Epub 2008 Jan 28. PMID: 23132992; PMCID: PMC3452526.
Shrikhande SV, Barreto SG, Bodhankar YD, Suradkar K, Shetty G, Hawaldar R, Goel M, Shukla PJ. Superior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: a comparative study evaluating perioperative outcomes. Langenbecks Arch Surg. 2011 Dec;396(8):1205-12. doi: 10.1007/s00423-011-0824-5. Epub 2011 Jul 8. PMID: 21739303.
Sanjay, P., Takaori, K., Govil, S., Shrikhande, S.V. and Windsor, J.A. (2012), ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg, 99: 1027-1035. https://doi.org/10.1002/bjs.8763

HPB surgery is defined by complexity, high stakes, and constant pressure, it’s easy to measure success in numbers: cases performed, papers published, positions held. But what does a sustainable, fulfilling career in HPB surgery really look like over decades of practice?
Dr Malini Bhana and Dr Brian Kiplagat Misoi are joined for our very first episode by Professor Eduard Jonas, President of the E-AHPBA. As head of surgical HPB training at the University of Cape Town, South Africa, Professor Jonas is extremely well published, with a special interest in CRLM and HCC.
However, the reason Professor Jonas was chosen to open this series extends far beyond his academic and clinical accomplishments. Having had the privilege of training under him during their fellowship, Malini and Brian witnessed firsthand not only his exceptional expertise, but also his leadership, genuine kindness, and remarkable approachability. These qualities, more than any title or achievement, embody what true success looks like.
 
Chapters:
00:00    Introduction of hosts and guests
02:16    Career and journey of Professor Eduard Jonas
06:34    The role of mentorship
11:11    Legacy initiatives in HCC
21:05    HPB Training programmes and support
26:20    Defining a meaningful legacy
 
Articles Referenced:
Jonas E, Smith M, Kassianides C, Luyirika E, Wendy Spearman C. IHPBA White Paper - The improvement of management pathways and access to care in sub-Saharan Africa for patients with hepatocellular carcinoma. HPB (Oxford). 2025 May;27(5):585-590. doi: 10.1016/j.hpb.2025.02.007. Epub 2025 Feb 18. PMID: 40037975.