Liver Resection Surgery

Liver resection, or hepatectomy, is a surgical procedure to remove a portion of the liver. It is commonly performed to treat both benign and malignant liver conditions.

Conditions Treated with Liver Resection

Benign Conditions:

  • Hepatocellular adenoma
  • Hepatic hemangioma
  • Focal nodular hyperplasia

Malignant Conditions:

  • Hepatocellular carcinoma
  • Metastases from colorectal cancer

Alternate Names for Liver Resection

  • Hepatic Resection
  • Hepatectomy

Preparation for Liver Resection Surgery

Proper preparation is crucial for successful outcomes. This includes addressing:

  • Coagulopathy and thrombocytopenia.
  • Ascites and portal hypertension.
  • Renal and pulmonary function.
  • Nutritional deficiencies, including vitamin B1 supplementation.

Laboratory Tests:

  • Serum bilirubin
  • Aspartate aminotransferase (AST)/platelet count ratio
  • Alanine aminotransferase (ALT)
  • Alkaline phosphatase

Imaging Studies:

  • Elastography for fibrosis assessment
  • Magnetic Resonance Imaging (MRI)
  • Hepatobiliary scintigraphy
  • Ultrasound-based tests for portal hypertension

In specific cases, additional tests like the indocyanine green retention test (ICG R15) may be conducted to predict surgical outcomes.

Liver Resection Surgical Techniques

  • Crush Technique:
    The liver tissue is crushed manually or using a surgical clamp for precise removal.
  • Ultrasound Dissection:
    Minimizes blood loss and reduces the chance of bile leakage.
  • Radiofrequency-Based Technique:
    Uses radiofrequency energy to coagulate liver tissue before resection.
  • Water-Jet Dissection:
    High-pressure water jets selectively remove unwanted liver tissue with minimal bleeding.
  • Vascular Stapler Method:
    A faster alternative to the crush-clamp technique, using a vascular stapler to reduce blood loss.
  • Minimally Invasive Techniques:
    These include laparoscopic, hand-assisted laparoscopic, and robotic-assisted methods. They offer shorter hospital stays and fewer complications.

Recovery After Liver Resection

Modern surgical advancements have significantly improved recovery outcomes.

  • Hospital Stay: Typically ranges from 5 to 10 days, or up to 3 weeks for more extensive procedures. Laparoscopic approaches allow patients to resume daily activities within a week.
  • At-Home Recovery Tips:
    • Take prescribed pain medication.
    • Follow a recommended diet and avoid alcohol.
    • Stay hydrated and engage in light walking.
    • Avoid lifting heavy weights for at least 8 weeks.

Follow-Up After Liver Resection

Regular follow-up is essential to monitor recovery and detect potential complications.

Emergency Follow-Up Is Needed for:

  • Persistent or increasing pain
  • Abdominal swelling (ascites) or leg swelling (edema)
  • Vomiting
  • Yellowing of the eyes and skin
  • Confusion

Routine Follow-Up Schedule:

  • Every 3 to 6 months for the first 2 years.
  • Every 6 to 12 months thereafter.

Tests Performed During Follow-Ups:

  • CT scans or MRIs to detect any remaining or spreading carcinoma.
  • Liver function blood tests.
  • Tumor marker tests, such as alpha-fetoprotein levels.

Potential Risks of Liver Resection

Though rare, some complications may occur, including:

  • Fever: May result from infections in the incision or venous catheter.
  • Hemorrhage: GI bleeding or intraperitoneal hemorrhage.
  • Bile Leakage: Reported in 4% to 17% of cases.
  • Liver Failure: Linked to preexisting hepatic conditions or surgical factors.
  • Pleural Effusion: Usually resolves on its own if symptoms are mild.

Liver resection is a complex but effective surgical option for treating certain liver conditions. Thorough preparation, skilled surgical techniques, and diligent follow-up care contribute to optimal outcomes.