Liver Surgery

The liver is the largest organ in the body, located in the upper right portion of the abdomen. It is one of the vital organs which regulates various bodily functions and supports the normal functioning of other organs in the body, as well. Some of the key functions of the liver are as follows:

• Converts sugar into energy
• Helps in digestion of fats
• Helps in excretion of waste products
• Protects against infections
• Produces blood clotting factors
• Regulates sex hormones and cholesterol level
• Supplies vitamins and minerals
• Metabolism and elimination of various drugs

Different liver disorders affect the normal functioning of the liver. Liver surgery includes various surgical procedures performed on the liver, for the management of different diseases affecting the liver. Resection is the most common surgical procedure performed on the liver and comprises of the removal of a portion of the liver. A malignant tumour is the most common indication for a liver resection.

Based on the origin, tumours in the liver are categorized into:

• Primary tumours: They develop within the liver.
• Metastatic tumours: They develop in some other organ and migrate to the liver, through the bloodstream.

Colon cancer is the most common cause of metastasis to the liver. Single or multiple tumours involving the different lobes of the liver can be resected with a high success rate, depending on the stage of the primary tumour.

Liver resection may also be employed for benign tumours of the liver such as cyst, adenoma, and hemangioma. For small and superficially located benign tumours a laparoscopic approach can be employed for the resection. Liver resection can also be performed as a part of live donor liver transplant in individuals who voluntarily donate a part of their liver to their relatives.

Liver resection does not require blood transfusion and requires about 3-5 hours. Up to 75% of the liver tissues can be securely removed by a liver resection. The patients may be required to stay in the hospital for about 5 days after the procedure. Liver is capable of regeneration. The complete regeneration of the resected liver, to its original size, may take 6-8 weeks. Good nutrition with a high protein diet is crucial for liver regeneration. However, cirrhotic liver or unhealthy liver is not capable of regeneration.

Contraindications

Patients undergoing liver surgery should be screened for various liver diseases that can affect the outcome of the surgery. Liver surgery is contraindicated in the following conditions:

• Acute or fulminant hepatitis
• Alcoholic hepatitis
• Severe chronic hepatitis

Other conditions associated with a variable risk following a liver surgery include obstructive jaundice, cardiac surgery and trauma.

Risks and complications

The common complications associated with liver surgery include:

• Liver failure
• Liver abscess
• Infection around the surgical site
• Bleeding
• Blood clots
• Bile leakage
• Pneumonia

Post-operative care

Some of the basic post-operative instructions for patients undergoing liver surgery are as follows:

• The dressing over the incision is usually removed 2-3 days after the surgery.
• Regular intake of the prescribed medications is necessary for best outcome.
• Walk and perform some physical activities to keep the lungs healthy and prevent blood clots.
• Avoid all consumption of alcohol.
• Do not eat or drink anything for the first few days after the surgery.
• Patients may gradually start on a liquid diet followed by solid foods, few weeks after the surgery.
• Avoid lifting heavy weights for at least 6-8 weeks.