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 tumor which is malignant.
The single tumor or more than one tumor 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) tumor.
Liver resections performed on patients with extrahepatic
disease may relieve the symptoms caused by the tumor, but offer little
improvement in survival. Benign tumors of the liver (cyst, adenoma, hemangioma)
can be successfully managed by liver resection as well.
If the location of a benign tumor 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 tumors.
In this case the removal of a portion of bile duct may be
necessary.
Depending on tumor location, complete
removal of the tumor 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.
