Liver resection is recommended to treat various types of liver disease such as both benign and malignant. This surgery is used for the following common benign conditions:
- Hepatocellular adenoma
- Hepatic hemangioma
- Focal nodular hyperplasia
The malignant conditions indicative of liver resection are as follows:
- Hepatocellular carcinoma
- Metastases due to colorectal cancer
In multispecialty centers, hepatic resections are performed by expert hepatobiliary surgeons who are specially trained for such surgical management.
Hepatic Resection, Hepatectomy
How is the surgery performed?
Several techniques can be used to perform the surgery.
The technique involves crushing the portion of the liver that has to be removed by a surgeon’s finger or surgical clamp (“crush-clamp”).
Liver resection is performed using ultrasound that involves low blood loss and a low chance of bile leak.
This technique applies radiofrequency energy to thermocoagulate the liver parenchyma that later helps in resection by a scalpel.
The method uses a high-pressure water jet to break apart the liver tissue and selectively remove the unwanted portions with minimal blood loss.
Vascular stapler method
This is an alternative to the crush-clamp technique. In this method, a vascular stapler is used to make the procedure faster with less blood loss and no requirement of transfusion.
Minimally invasive technique
In recent times, minimally invasive techniques such as total laparoscopic, hand-assisted laparoscopic, and robotic-assisted surgery have gained popularity due to their better outcome, shorter hospital stays, and fewer postoperative complications.
Considerations and corrections of the following factors are primarily required for patients undergoing hepatic resection:
- Correction of coagulopathy and thrombocytopenia.
- Assessment and correction of ascites.
- Evaluation of renal dysfunction and pulmonary disease.
- Improvement of nutritional status and vitamin B1 supplementation.
The following blood tests for liver function are performed:
- Serum bilirubin
- Serum aspartate aminotransferase activity/platelet count ratio
- Alanine aminotransferase
- Alkaline GGT Phosphatase.
- Elastography (for noninvasive fibrosis assessment)
- Hepatobiliary scintigraphy
- Magnetic resonance imaging (MRI)
- USG based test for portal hypertension
In some special disease-specific cases, tests such as the indocyanine green retention test (ICG R15) is required to predict surgical outcome.
Surgery, noninvasive surgery
An emergency follow-up is required for the following cases:
- Pain or an increased pain
- Swelling in the abdomen (ascites) or legs (edema)
- Yellowing of the eyes and skin
Normally, follow-up visits are scheduled every 3 to 6 months for 2 years, then every 6 to 12 months as the highest chance of recurrence is within 2 years.
During the check-up, besides physical examinations, doctors may perform the following tests:
- A CT scan or an MRI of the liver and other parts of the abdomen to look for carcinoma that may remain after treatment or that has spread.
- Blood tests, including liver function tests, to check how well your liver is working.
- Blood tests to check tumor marker levels of alpha-fetoprotein to see if they lowered after treatment.
Some rare postoperative complications involved with hepatectomy are
- Fever: Due to infection in the venous catheter, UTI, or incisional infection.
- Hemorrhage: GI bleeding, coagulopathy, or intraperitoneal hemorrhage
- Bile leakage: Can occur in 4.0% to 17% cases.
- Liver failure: Associated with several hepatic diseases and surgical factors.
- Pleural effusion: It may spontaneously resolve, and if the patient has no significant symptoms or signs, no special treatment will be needed.
In present times, the evolution of modern surgical techniques, new ways of controlling bleeding, and better in-patient care has improved the perioperative outcome.
Patients need to spend 5–10 days or a maximum of three weeks in the hospital after hepatectomy. If laparoscopy is performed, the recovery time is shorter and the patient can return to daily activities within a week. Drips and drains are removed before they leave the hospital.
Following recovery tips can be followed at home:
- Take pain medications as prescribed.
- Recommended diet and no consumption of alcohol.
- Exercise and walking.
- Consuming plenty of fluids.
- No lifting heavy weights for 8 weeks post-surgery.
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