Liver The liver is the largest human organ and has the potential to regeneration and growth after partial resection. This attribute, which was already known by the ancient greeks (saga of Prometheus) allows to operate liver repeatedly without causing an ongoing functional deficit. The main job of the liver is to decontaminate the body from sludge products and to form key factors for protein synthesis among them coagulation factors, albumin and many proteins that are important for wound healing and muscle build up. Operations on the liver are mostly necessary due to tumors which have either originated in the liver or more frequently due to metastases from tumors that have grown in other organs. The options for treatment are very comprehensive. The surgeon does not work alone in this scenario, but works in close collaboration gastroenterologists, oncologist and radiologist as well as with pathologists. Together it is possible in many cases to free the liver from metastases even if there are many of them in both main lobes. This requires sometimes several steps, procedures or operations, but in this way allows the liver for interim regeneration. In the following you find an overview over the most frequent liver operations Liver surgery Atypical liver resection In this operation there is removal of one or more parts of the liver by so called wedge resections. This is often sufficient in small peripheral tumors. The small defect that remains is frequently closed by growth and regeneration in due course. The hospital stay is usually only 5-7 days. Right/Left hemihepatectomy In this much larger operation the right or left half of the liver is completely removed. This operation is frequently done if colorectal or other cancer metastases are present. Because the liver has two main lobes (each has 4 segments) either lobe can be removed provided that the remaining liver is healthy. It will then grow quickly and can reach 85% of the original size after a few weeks. Extended right/left hemihepatectomy In this very large liver operation approximately 75% of the liver (6 of 8 Segments) are removed. This procedure must be performed in many cases of the so called Klatskin tumor (a malignant tumor of the bile system) or in excessive liver metastasis sparing the left lateral segments. Because the right or left bile duct is being removed along with the liver tissue a small bowel loop must be connected to the draining bile duct of the remaining liver to provide bile outflow and drainage. Possible complications Risks of this operation are biliary leakage (because the bile ducts have been transsected), bleeding and infection. With inceasing amount of liver tissue removal the risk of liver dysfunction or worse complete liver failure increases. The mortality risk is around 8%, hospital duration is 10-14 days.
Posted on: Wed, 09 Oct 2013 08:37:18 +0000
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