MCh Hepato Pancreato Biliary Surgery: Admissions, medical colleges, fees, eligibility criteria details

Written by Dr Nitisha Kalia Published On 2023-02-24T17:03:25+05:30 | Updated On 16 Dec 2023 3:49 PM IST

MCh Hepato Pancreato Biliary Surgery: Admissions, medical colleges, fees, eligibility criteria details

MCh Hepato Pancreato Biliary Surgery or Master of Chirurgiae in Hepato Pancreato Biliary Surgery also known as MCh in Hepato Pancreato Biliary Surgery is a super specialty level course for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of this super specialty course is 3 years, and it deals with the diagnosis and management of benign and malignant diseases of the liver, pancreas, and biliary tree.

The course is a full-time course pursued at various recognized medical colleges across the country. Some of the top medical colleges offering this course include the Institute of Liver and Biliary sciences, New Delhi, CMC Vellore, and Mahatma Gandhi Medical College and hospital, Sitapur, Jaipur, Rajasthan.

Admission to this course is done through the NEET-SS Entrance exam conducted by the National Board of Examinations, followed by counseling based on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing MCh (Hepato Pancreato Biliary Surgery) varies from college to college and may range from Rs.2,07,000 to Rs 29,00,000 per year.

After completion of their respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programs recognized by NMC and NBE. Candidates can take reputed jobs at positions as Senior residents, Consultants, etc. with an approximate salary range of Rs 25 lakhs to Rs. 41 lakhs per annum.

What is MCh in Hepato Pancreato Biliary Surgery?

Master of Chirurgiae in Hepato Pancreato Biliary Surgery, also known as MCh (Hepato Pancreato Biliary Surgery) or MCh in (Hepato Pancreato Biliary Surgery) is a three-year super specialty program that candidates can pursue after completing a postgraduate degree.

Hepato Pancreato Biliary Surgery is the branch of medical science dealing with the diagnosis and management of benign and malignant diseases of the liver, pancreas, and biliary tree.

National Medical Commission (NMC), the apex medical regulator, has released a Guidelines for Competency-Based Postgraduate Training Programme for MCh in Hepato Pancreato Biliary Surgery.

The Competency-Based Postgraduate Training Programme governs the education and training of MCh in Hepato Pancreato Biliary Surgery.

The postgraduate students must gain ample knowledge and experience in the diagnosis, and treatment of patients with acute, serious, and life-threatening medical and surgical diseases.

PG education intends to create specialists who can contribute to high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Hepato Pancreato Biliary Surgery would help the specialist to recognize the health needs of the community. The student should be competent to handle medical problems effectively and should be aware of the recent advances in their specialty.

The candidate is also expected to know the principles of research methodology and modes of the consulting library. The candidate should regularly attend conferences, workshops, and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of MCh in Hepato Pancreato Biliary Surgery

Name of Course	MCh in Hepato Pancreato Biliary Surgery
Level	Doctorate
Duration of Course	Three years
Course Mode	Full Time
Minimum Academic Requirement	Candidates must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.
Admission Process / Entrance Process / Entrance Modalities	Entrance Exam (NEET-SS) INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru Counseling by DGHS/MCC/State Authorities
Course Fees	Rs.2,07,000 to Rs 29,00,000 per year
Average Salary	Rs 25 lakhs to Rs.41 lakhs per year

Eligibility Criteria

The eligibility criteria for MCh in Hepato Pancreato Biliary Surgery are defined as the set of rules or minimum prerequisites that aspirants must meet to be eligible for admission, which includes:

Name of Super Specialty course

Course Type

Prior Eligibility Requirement

Hepato Pancreato

Biliary Surgery

MCh

MS/DNB (General Surgery)

Note:

· The feeder qualification for MCh Gynaecological Oncology is MS/DNB (General Surgery) and is defined by the NBE and is subject to changes by the NBE.

· The feeder qualification mentioned here is as of 2022.

· For any changes, please refer to the NBE website.

The prior entry qualifications shall be strictly by Post Graduate Medical Education Regulations, 2000, and its amendments notified by the NMC and any clarification issued from NMC in this regard.
The candidate must have obtained permanent registration with any State Medical Council to be eligible for admission.
The medical college's recognition cut-off dates for the Postgraduate Degree courses shall be as prescribed by the Medical Council of India (now NMC).

Admission Process

The admission process contains a few steps to be followed in order by the candidates for admission to MCh in Hepato Pancreato Biliary Surgery. Candidates can view the complete admission process for MCh in Hepato Pancreato Biliary Surgery mentioned below:

The NEET-SS or National Eligibility Entrance Test for Super specialty courses is a national-level master's level examination conducted by the NBE for admission to DM/MCh/DrNB Courses.
Qualifying Criteria-Candidates placed at the 50th percentile or above shall be declared as qualified in the NEET-SS in their respective specialty.
The following Medical institutions are not covered under centralized admissions for DM/MCh courses through NEET-SS:

1. AIIMS, New Delhi, and other AIIMS

2. PGIMER, Chandigarh

3. JIPMER, Puducherry

4. NIMHANS, Bengaluru

Candidates from all eligible feeder specialty subjects shall be required to appear in the question paper of the respective group if they are willing to opt for a super specialty course in any of the super specialty courses covered in that group.
A candidate can opt for appearing in the question papers of as many groups for which his/her Postgraduate specialty qualification is an eligible feeder qualification.
By appearing in the question paper of a group and on qualifying for the examination, a candidate shall be eligible to exercise his/her choices in the counseling only for those super specialty subjects covered in the said group for which his/ her broad specialty is an eligible feeder qualification.

Fees Structure

The fee structure for MCh in Hepato Pancreato Biliary Surgery varies from college to college. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for MCh in Hepato Pancreato Biliary Surgery is around may range from Rs.2,07,000 to Rs.29,00,000 per year.

Colleges offering MCh in Hepato Pancreato Biliary Surgery

Various medical colleges across India offer courses for pursuing MCh in (Hepato Pancreato Biliary Surgery).

As per National Medical Commission (NMC) website, the following medical colleges are offering MCh in (Hepato Pancreato Biliary Surgery) courses for the academic year 2022-23.

Sl.No.	Course Name	State	Name and Address of Medical College / Medical Institution	Annual Intake (Seats)
1	M.Ch - Hepato Pancreato Biliary Surgery	Delhi	Institute of Liver and Biliary Sciences, New Delhi	6
2	M.Ch - Hepato Pancreato Biliary Surgery	Rajasthan	Mahatma Gandhi Medical College and Hospital, Sitapur, Jaipur	1
3	M.Ch - Hepato Pancreato Biliary Surgery	Tamil Nadu	Christian Medical College, Vellore	2

Syllabus

An MCh in Hepato Pancreato Biliary Surgery is a three years specialization course that provides training in the stream of Hepato Pancreato Biliary Surgery.

The course content for MCh in Hepato Pancreato Biliary Surgery is given in the Competency-Based Postgraduate Training Programme released by National Medical Commission, which can be assessed through the link mentioned below:

NMC Guidelines For Competency-Based Training Programme For MCh Hepato Pancreato Biliary (HPB) Surgery

5.1 The Liver

A. Anatomy, Embryology, Physiology, Investigations

1. Embryology of the liver and relationship to other foregut structures

2. Extrahepatic anatomy of the liver

• Lobes, sectors, segments

• Nomenclature systems

• Ligaments, fissures and incisures

• Anomalies

3. Anatomy of the porta

• Portal vein, hepatic artery

• Bile duct, gall bladder

• Variants of normal and anomalies

• Lymphatic drainage and nodal anatomy

• Nerves

4. Anatomy of the retrohepatic space

• IVC and its branches

• Adrenal, kidney, diaphragm

5. Intrahepatic anatomy

• Hepatic veins and variants of normal

• Portal triad structures and segmental anatomy

• Histology of the normal liver

6. Physiology of the liver

• Bilirubin metabolism

• Coagulation

• Other clinically relevant metabolic pathways

7. Haematologic, biochemical, and histologic investigations(assessment) of the liver

• Transaminases and markers of cholestasis

• Measures of liver function

(a) Static – including INR (PT), Factors V and VII, bilirubin, albumin

(b) Dynamic – including clearance tests, e.g. ICG, galactose, aminopyrine, lidocaine (MEGX)

(c)Indicators of portal hypertension including hepatic venous pressure gradient

• Indications for liver biopsy

8. Imaging of the liver

• Ultrasound (U/S) and Doppler, Computerized Tomography (CT) Scans, Magnetic Resonance Imaging (MRI) Scans

• Nuclear tests: Proton Emission Tomographic (PET) Scans, Liver/Spleen scans, Biliary excretion (e.g. HIDA) scans, RBC scans

9. Application of investigations to hepatic surgery

B. Congenital and Acquired Non-neoplastic Liver Disease

1. Paediatric liver diseases, Biliary atresia, and Alalegille's syndrome

(a) Presentation, evaluation, and natural history

(b) Treatment options and indications for intervention

2. Liver cysts and abscesses

a. Solitary liver cysts

• Presentation, evaluation, and natural history

• Distinguish from cystic neoplasm

• Treatment options and indications for intervention

b. Polycystic liver disease

• Associated abnormalities

• Presentation, evaluation, and natural history

• Treatment options and indications for intervention

c. Pyogenic and fungal liver abscess

▪ Potential bacterial and fungal pathogens and sources

• Presentation, evaluation

▪ Treatment and indications for surgical drainage of liver abscess including amoebic abscess

d. Tuberculous abscess TB Presentation, evaluation, and natural history

• Treatment options and indications for intervention

e. Echinococcal liver cyst

• Life cycle, epidemiology, target organs

• Presentation, evaluation, and natural history

• Treatment options and indications for intervention

3. Liver failure

• Hepatitis and acute liver failure

▪ Causes of acute liver failure

▪ Investigation and prognosis

▪ Classification systems including MELD and King's College criteria

▪ Treatment strategies

▪ Role of liver support systems

▪ Role of liver transplantation

4. Cirrhosis and portal hypertension

(a) Causes of cirrhosis, diagnosis, and natural history, staging, and treatment options (including indications for liver transplantation) for each

i. Viral hepatitis B, C, D

ii. Alcoholic liver disease

iii. Non-alcoholic fatty liver disease and steatohepatitis

iv. Autoimmune liver disease

v. Primary biliary cirrhosis

vi. Primary sclerosing cholangitis

vii. Haemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency

viii. Budd-Chiari syndrome

(b) Portal hypertension

i. Pathophysiology

ii. Interpretation of haematologic and biochemical tests and imaging

iii. Non-operative treatment options and strategies

iv. Portosystemic decompression

1. Indications and sequelae

2. Risks and benefits of TIPS

3. Surgical shunts, types

4. Devascularisation procedures

v. Indications for liver transplantation

C. Neoplastic Liver Disease a. Benign neoplasms of the liver

• Presentation, investigation, diagnosis, and natural history of hemangioma, hamartoma, adenoma, focal nodular hyperplasia

• Histology and indications for biopsy

• Treatment options and indication for ablation or resection

b. Primary malignancies of the liver

1. Hepatocellular carcinoma (HCC)

▪ Aetiology, presentation, investigation, diagnosis, and natural history of HCC

▪ Role of screening and staging systems for HCC

▪ Treatment options and the risk: benefit-ratio for each: resection, transplantation, ablation, chemotherapy with or without embolization, radiation

2. Cholangiocarcinoma (intrahepatic or peripheral)

• Diagnosis, investigation, and staging

• Treatment options including palliative procedures

3. Epithelioid haemangioendothelioma, lymphoma, sarcoma, and other neoplasms

• Diagnosis, investigation, and staging

• Treatment options

c. Secondary malignancies of the liver

❖ Colorectal primary

• Pathogenesis, staging of colorectal cancer

• Investigation and staging

• Treatment options

➢ Indications, and risk-benefit ratio of ablation/resection

➢ Neo-adjuvant, downstaging, and adjuvant chemotherapy

❖ Neuroendocrine and another primary

• Investigation and staging

• Treatment options

➢ Indications, and risk-benefit ratio of ablation/resection

➢ Neoadjuvant and adjuvant therapy

D. Liver Surgery Types of liver resection

• Nomenclature of liver resections (Brisbane system)

• Laparoscopic, laparoscopic-assisted, open laparotomy

• Nonanatomic, segmental, lobectomy, extended lobectomy

• Vascular control: none, Pringle maneuver, total vascular isolation

• Vascular resection and reconstruction

• Staged resections

• Combination with ablation Preoperative assessment and the cumulative risks to the proposed procedure

• Patient comorbid condition (cardiopulmonary and other)

• Hepatic risk

(a) Assessment of liver function, portal hypertension

(b) Volumetric assessment of liver remnant

• Prophylaxis against common complications such as DVT, infection

• Neuroendocrine hormonal blockade

• Detailed operative plan based on preoperative imaging Liver resection

1. Anaesthetic considerations: Agents, coagulation, CVP

2. Blood loss conservation including cell saving and blood product administration

3. Laparoscopic techniques

(a) Patient and port placement

(b) Hand port

4. Parenchymal transection techniques

(a) Relative advantages and disadvantages

(b) Normal, fatty, fibrotic, and cirrhotic parenchyma

(i) Diaphragm

(ii) IVC

(iii) Portal vein

(iv) Bile duct and

(v) hepatic artery Post-operative management Complications and management, including liver failure

5.2 The Biliary Tract including Gallbladder

A. Anatomy, Embryology, Physiology, Investigations

1. Embryology of the biliary tract

• Relationship to the liver, pancreas, and other portal and foregut structures

2. Anatomy of the hepatic duct and biliary plate

• Segmental anatomy and variants of normal

• Blood supply and lymphatic drainage

• Relationship with other portal structures

3. Anatomy of the gallbladder and cystic duct

• Blood supply and lymphatic drainage

• Variants of normal and anomalies

4. Anatomy of the bile duct

• Blood supply, lymphatic drainage, and regional lymph nodes

• Variants of normal and anomalies

• Relationship with other portal structures and the pancreatic duct

• Sphincter of Oddi and ampulla of Vater

5. Bile metabolism and biliary physiology

• Bile-salt dependent and independent bile production

• Hormonal influences

• Biliary epithelium and gallbladder function

• Sphincter of Oddi motility

6. Interpretation of biochemical investigations

7. Imaging

• Axial and body imaging techniques: U/S, CT scan and MRI scan, including MRCP

• Endoscopic U/S

• Direct contrast imaging

(a) Percutaneous transhepatic cholangiogram (PTC) and cholecystography

(b) Endoscopic retrograde cholangiopancreatography (ERCP)

• Endoscopic assessment of the ampulla of Vater

• Nuclear biliary excretion imaging (HIDA scan) – qualitative and quantitative

B. Congenital and Non-neoplastic Biliary Disease

a. Congenital and pediatric Choledochal cyst, Caroli's disease, congenital hepatic fibrosis, biliary atresia, and Alalegille's syndrome

1. Presentation, classification, evaluation, and natural history

2. Treatment options and indications for intervention

b. Gallstones

1 Pathogenesis

2 Presentation and investigation of biliary colic, cholecystitis, cholangitis, Mirrizzi's syndrome, gallstone ileus

3 Treatment: Percutaneous, laparoscopic and open 4 Cholecystectomy-related biliary injuries

(a) Mechanism of injury and classification

(b) Associated injuries

c. Benign strictures

1. Primary sclerosing cholangitis (PSC)

(a) Aetiology, pathophysiology, natural history, and nonoperative management

(b) Complications and management

i. Screening for cholangiocarcinoma

ii. PTC with biliary drainage (PTBD), ERCP with endobiliary stent

iii. Resection

iv. Transplantation

2. Post-traumatic and idiopathic

(a) Mechanism of injury and classification

(b) Management options d. Intrahepatic stones

1. Pathophysiology, presentation, and investigation

2. Common infectious bacteria

3. Surgical options including liver resection and biliary access (Hutson) choledochojejunostomy, hepaticojejunostomy with transhepatic stents

C. Neoplastic Biliary Disease a. Gallbladder

(1) Polyps

1. Presentation, natural history

2. Indications for resection

3. Principles of resection

(2) Adenocarcinoma

1. Presentation, staging (including histology), and natural history

2. Investigation

3. Surgical options: Extent and timing of resection

4. Chemo and radiotherapy including neo- and/or adjuvant therapy

5. Palliative care options

b. Bile duct

(1) Adenoma of ampulla of Vater

1. Presentation, natural history, investigation

2. Resection options: Endoscopic, transduodenal resection, and reconstruction

(2) Adenocarcinoma

1. Location: Hilar (Klatskin), intrapancreatic, ampulla

2. Type: papillary, sclerosing

3. Presentation, investigation, and staging, including laparoscopic staging

4. Resection and reconstruction: indications and contraindication

5. Palliative options

1. PTBD or endoscopic stent

2. Surgical bypass

5.3 The Pancreas and Duodenum A

. Anatomy, Embryology, Physiology, Investigations

• Embryology of the pancreas and duodenum

(1) Relationship to the liver, bile duct, and other foregut structures

(2) Aetiology of anomalies including pancreas divisum and annular pancreas

• Anatomy of the pancreas

(1) Spectrum of normal anatomy and variants

(2) Arterial supply and venous drainage

(3) Lymphatic drainage and regional lymph nodes.

(4) Relationship with:

• Portal structures: duodenum, bile duct, hepatic artery, portal vein, splenic and superior mesenteric veins, and their branches

• Retroperitoneum: IVC and its branches, aorta, and SMA and their branches, adrenal gland, kidneys

• Adjacent organs: stomach, spleen, colon, small intestine

• Anatomy of the pancreatic duct • Variants of normal and anomalies

• Anatomy of the duodenum

(1) Spectrum of normal anatomy and variants

(2) Arterial supply and venous drainage

(3) Lymphatic drainage and regional lymph nodes.

(4) Relationship with:

• Portal structures: bile duct, hepatic artery, portal vein, splenic and superior mesenteric veins, and their branches

• Retroperitoneum: IVC and its branches, aorta, and SMA and their branches, adrenal gland, kidneys

• Adjacent organs: pancreas, stomach, spleen, colon, small intestine

• Pancreatic metabolism and physiology

(1) Exocrine enzyme physiology

(a) Synthesis, excretion, and activation

(b) Neural and hormonal influences

(2) Endocrine metabolism

(a) Islet cell function, neuroendocrine hormones

• Duodenal physiology

(1) Motility

(2) Neuroendocrine ("gut") hormone physiology

(3) Biochemical investigation and interpretation

• Biochemical investigations

(1) Markers of pancreatic injury

(2) Measures of pancreatic exocrine function

(3) Urinary and serum neuroendocrine hormones

• Imaging

(1) Axial and body imaging techniques: U/S, CT scan, and MRI scan, including

• MRCP

(2) Endoscopy and endoscopic U/S

(3) Direct contrast imagingEndoscopic retrograde cholangio-pancraetography (ERCP)

(4) Nuclear studies:

▪ PET scan

▪ Neuroendocrine imaging (Octreotide scan)

(5) Application of investigations and imaging to pancreatic and duodenal surgery

B. Congenital and Acquired Non-neoplastic Pancreatic Disease

1. Pancreatitis

(1) Acute

1. Pathogenesis, staging, and prognosis

2. Management, including surgical options and complications

3. Indications for surgical intervention

(2) Chronic

1. Pathogenesis, complications, and nonoperative management

2. Pancreatic stents and endoscopic/percutaneous drainage procedures

3. Surgical options and indications

4. Pain control

2. Pancreas divisum

(1) Pathogenesis, staging, and prognosis

(2) Management, including surgical options and complications

(3) Indications for surgical intervention

3. Annular pancreas

(1) Pathogenesis, staging, and prognosis

(2) Management, including surgical options and complications

(3) Indications for surgical intervention

C. Neoplastic Diseases Benign cysts and neoplasms of the pancreas

(1)Microcystic serous cystadenoma