Liver Surgery
Liver
surgery comprises various operations of the liver for different disorders. The
most common operation performed on the liver is a removal of a portion of the
liver that becomes diseased. The most typical reason for liver resection is a
tumour which is malignant.
The
single tumour or more than one tumour confined to either left or right side of
the liver can be successfully resected with good survival rates. Liver
resection patients are carefully evaluated by a multidisciplinary team to
ensure the absence of the extrahepatic (outside the liver) tumour. Liver
resections performed on patients with extrahepatic disease may relieve the
symptoms caused by the tumour, but offer little improvement in survival.
Benign
tumours of the liver (cyst, adenoma, hemangioma) can be successfully managed by
liver resection as well. If the location of a benign tumour is superficial and
small in size, the operation can be performed laparoscopically (by making small
punctures in the abdomen while viewing through a video camera). Liver resections
are also performed on people willing to donate part of their liver to a loved
one (see live donor liver transplant).
A
liver resection takes approximately 3-5 hours and can be performed without the
need for blood transfusion (see bloodless surgery). Up to 75% of the liver
tissue can be safely removed. The hospital stay is about 5 days and complete
recovery occurs in 5-6 weeks. The resected liver regenerates to its
preoperative size in 6-8 weeks. Excellent results from liver resections are
usually achieved.
Gallbladder/Bile
Duct Surgery
The
bile duct system and gallbladder (collectively known as the biliary tree) are
involved in the drainage and delivery of bile from the liver into the intestine.
Bile
production is one of the most vital functions of the liver and it is necessary
for the appropriate absorption of nutrients from the intestine. Disorders of
the biliary tree can alter this function. The gallbladder is located underneath
the liver and the bile duct extends from inside the liver into the duodenum
(initial portion of the small intestine just past the stomach).
The
bile duct has an extrahepatic portion (outside the liver) and intrapancreatic
portion (within the pancreas). The most common disorder of the biliary tree is
cholelithiasis or gallstones.
Gallstones
are usually located in the gallbladder and, if symptomatic, can be removed
laparoscopically (without open surgery) along with the gallbladder. There is a
1 to 2 day hospital stay after this operation and full recuperation time is
about two weeks. The presence of gallstones can be complicated by acute
pancreatitis (see pancreatic surgery). The biliary tree can be a site for the
growth of malignant tumours. In this case the removal of a portion of bile duct
may be necessary.
Depending
on tumour location, complete removal of the tumour may also involve concomitant
resection of the liver (see liver surgery) or pancreas (see pancreatic
surgery). Certain diseases of the biliary tree (i.e. primary sclerosing
cholangitis) may also injure the liver and progress to end-stage liver disease.
In such cases liver transplantation may be the only option (see liver
transplantation).
Operations
on the biliary tree can be done very safely and usually without blood
transfusion (see bloodless surgery). If major resections of liver or pancreas
are involved, the operative time is about 3-6 hours. The hospital stay is about
7 days and full recuperation time is about 6 weeks. Under most circumstances,
excellent outcomes are usually achieved.
Portal Hypertension
Surgery
The liver filters venous blood from abdominal organs. Portal
hypertension is increased blood pressure in the veins of abdominal organs. The
primary vein that carries blood from the abdominal organs to the liver is
called the portal vein.
When this vein clots or when the liver develops scar tissue from
disease and compresses the vein, the blood pressure in the vein goes up and
portal hypertension develops. Blood backing up in the veins of abdominal organs
causes typical signs of portal hypertension such as ascites to develop.
Ascites is free fluid in the abdomen caused by blood being under
high pressure and some of its liquid portion squeezing through the vessels and
settling in the abdomen. Hypersplenism is an enlarged spleen caused by blood
congestion and increased destruction of blood cells due to spleen
hyperactivity. Gastrointestinal bleeding (bleeding into the stomach) results
from rupture of varicose veins in the stomach and esophagus (swallowing tube).
Varicose veins form a collateral venous network for the blood to
escape into an area of lower pressure. Portal hypertension can be accompanied
by good liver function with good production of all necessary proteins. In such
instances liver transplantation is not indicated (see liver transplantation).
For long-term management an operation called portal vein shunting can be
considered.
During this operation the surgical connection
between the portal vein or its branches and the vena cava (low-pressure vein
caring blood from lower extremities and kidneys to the heart) or its branches
is created. This allows blood from the portal vein to be redirected into the
vena cava resolving the portal hypertension. This operation can be performed in
selected patients with excellent long-term results.
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