Liver Surgery

The liver is a large organ in the upper abdomen, just below the diaphragm. It is a major source of proteins for the body and processes much of the food we eat. It also secretes bile via the bile ducts into the gut. The gallbladder stores bile. It is connected to the main bile duct and hangs off the liver.

The liver receives blood from two sources: the portal vein and the hepatic artery. Blood leaves the liver through hepatic veins into the vena cava just below the diaphragm. The liver is divided into eight anatomical segments by the branches of its veins. This anatomy provides the basis for most resections of the liver.

Regenerattion: The liver is able to regenerate its substance. This means that when part of the liver is removed, the volume of the remaining liver increases until it is close to the volume of the original whole liver. Bile ducts and blood vessels do not re-grow. In general, up to 70% of a healthy liver can be removed, however, when there is chronic liver disease present, much less can be removed safely.

The most common reason for liver resection is potentially curable cancer. The most common of these, in this country, is spread (secondaries) from a bowel cancer when there is no spread to other organs. The next most common is for hepatocellular carcinoma (Hepatoma, HCC). This is a cancer that originates in liver cells (primary) and is usually associated with chronic liver disease.

It is unusual to resect other cancers, although it is sometimes performed for cholangiocarcinoma (cancer of the bile duct), gallbladder cancer, and for secondaries from; neuroendocrine tumours (like carcinoid), renal cancer, melanoma, and rarely other cancers. There are a number of benign lesions that can occur in the liver, most don’t cause any symptoms or problems and can be safely watched or left alone, however it is occasionally necessary to resect certain benign lesions including adenoma, cholangiohepatitis, and giant haemangiomas.

Sometimes it is not possible to be sure of a diagnosis before surgery even with modern imaging techniques. Biopsy of the liver is not routinely recommended because it has the potential to cause bleeding and spread cancers. Therefore, occasionally someone may have a resection for what turns out to be a benign condition because the suspicion for curable cancer was high

There are two broad methods:

Open Resction: This is the preferred method for major resections particularly if the tumour is close to a major blood vessel. It is also used for minor resections in difficult to access parts of the liver.

Laparoscopic (Keyhole) : This is a newer method and uses a camera inserted into the abdominal cavity along with several other small cuts to introduce instruments. It is sometimes necessary to make a hole large enough to insert a hand into the abdomen to assist with safe resection (hand-assisted technique). The liver piece is removed through a small enlargement of one of the incisions

With both methods, the principals are the same: The liver is mobilized. The vessels to the portion being resected are frequently tied. The parenchyma (meat) of the liver is then cut through using a variety of techniques. Care is taken to seal off the blood vessels and bile ducts that course through the liver. A normal rim of liver tissue is removed around the tumour to ensure clear margins.

The post-operative course is different for each person and differs greatly between open and laparoscopic surgery. Most patients are admitted to Intensive Care or the High Dependency Unit for the first post-operative night. Those having laparoscopic surgery can expect to stay between 1 and 4 nights in hospital. Those having open surgery stay between 5 and 10 days on average. Most patients will be able to take oral intake within 24hours of surgery. Those having laparoscopic surgery should expect to take 2-3 weeks away from work. Those having open surgery can expect 6-12 weeks away from work.

ERCP is a safe and well-tolerated procedure when performed by specialist doctors trained and experienced in the technique. Although complications requiring hospitalisation can occur, they are uncommon. Complications can include:

Pancreatitis (inflammation of the pancreas)

Infections

Bowel Perforation

Bleeding

Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Pancreatitis is the most frequent serious complication and causes pain in the abdomen. It is usually mild and settles within a couple of days in hospital with pain relief, bowel rest and intravenous fluids. However, occasionally pancreatitis can more severe, and very rarely can even result in death. Since the risks vary with each patient you should have a detailed conversation with your doctor about the risks to you.