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Liver Surgery

9

Why do I need this operation?

You need this operation because it is the most

effective way of removing the tumour(s) in your

liver.

What are the likely benefits?

Surgical removal of the tumour(s) offers the only

potential cure.The intended benefit is that the

operation will extend your life expectancy; that

is, you will live longer having had the operation

than if you do not.

How is the operation performed?

Liver surgery is traditionally performed by an

open operation through an incision that often

spreads across both sides of the upper part of

the abdomen.We first disconnect the blood

supply to the part of the liver that carries the

tumour(s).We then cut through the liver using

special devices that help us minimise the blood

loss during the surgery, although sometimes a

blood transfusion may be required.

More recently, liver tumours have been safely and

successfully removed by ‘keyhole’ (laparoscopic)

surgery. However, laparoscopic surgery is not

suitable for all patients.This is for a number of

reasons including, not all tumours can be removed

by laparoscopic surgery, you may have other

medical conditions or you may have had previous

abdominal surgery.

In principle, laparoscopic liver resection is the

same as an open operation, but is performed

through smaller cuts.Whenever we do a

laparoscopic operation, however, there is a chance

that we may need to convert to a traditional open

operation, if faced with a difficulty that we cannot

overcome by laparoscopic surgery.The chance of

a conversion to open surgery may be as high

as 1 in 10 patients (10%). Laparoscopic surgery

is carried out through a few small cuts on the

abdomen, with the use of gas (carbon dioxide)

to inflate the abdomen.The operation is then

performed using a special camera to visualise the

liver, and special instruments. Sometimes, one of

the cuts is made longer than others in order for

the surgeon to place one hand in the abdomen

to help with the surgery (this is called hand-assisted

laparoscopic surgery) and through which the

surgeon finally removes the resected part of

the liver.

For both types of liver surgery, after the tumours

have been removed a glue-like substance is usually

poured or sprayed onto the liver to help prevent

bleeding after the operation. Everything is carefully

checked and then the incision is closed with several

layers of stitching.

Laparoscopic Liver Surgery

at London Bridge Hospital

Mr Parthi Srinivasan

Before any surgery, open or laparoscopic, the

team will assess your clinical condition and review

your scans to determine how your tumour(s)

could be best removed.All your tests and

scans will be reviewed by a team of doctors

(the multidisciplinary team), which includes

your consultant.The team will recommend the

treatment it feels will be best for you. Obviously,

this recommendation will be thoroughly discussed

with you before a final decision about treatment

is made.

If it was not clear from your radiology test or

other scans, whether the tumour is removable,

your surgeon may carry out a diagnostic test called

a laparoscopy (key-hole operation) to evaluate

the tumour further. If this shows that the tumour

has spread outside of the liver or bile ducts, the

surgeon will not carry out the formal resection.

What are the risks?

Some risks are common to all operations, such

as chest infection and blood clots forming in your

veins (DVT) or in the lungs (pulmonary embolus).

However, there are also specific risks associated

with liver surgery:

1.

Bleeding: the liver is well supplied with blood

and one of the major risks of liver surgery

is bleeding.You will lose blood during the

operation and this will be replaced with blood

transfusions as required. Occasionally, bleeding

can occur after the operation and a further

operation may be necessary to stop this.

Specific blood will be kept ready for you,

should you need a transfusion.

Transfusion itself carries some risks and would

not be given, except when absolutely necessary.

If you have any objections to receiving blood

or blood products (such as platelets), it is

essential that you inform your surgeon and/or

anaesthetist before your operation.

2.

Bile leak: the liver can leak bile from where

it has been cut. If your liver does leak bile in

this way, then other procedures may be

required to control this.The reconnections

(or anastomoses) that the surgeon creates

during the operation can sometimes leak,

and if this happens, then further drains (to

drain the leaking fluid to the outside) may

be necessary. If this happens, you may need

to return to theatre for further surgery,

although this is rarely necessary.

3.

Liver decompensation: if your tumour(s) are

large or dispersed within the liver, then a large

part of your liver may have to be removed.

This will leave your body with a much smaller

amount of liver.As explained earlier, in time

this liver will re-grow to take the place of the

liver that has been removed. However, in the

short-term after the operation, your smaller

liver may struggle to do all that it is meant to.

The symptoms of this can be jaundice (your

skin becomes yellow) and a build up of fluid

in your abdomen.These problems will usually

settle down after a week or two. In a very small

number of patients, this may be associated with

other organs not functioning properly, such as

low blood pressure, pneumonia and kidney

failure.

4.

Infection: this may involve the wound, the drain

sites or the inner organs.Antibiotics will be given

to you at the time of surgery to try to prevent

an infection developing.

5.

Advanced disease: as noted earlier, sometimes

it is not clear from radiology or other scans

whether or not the tumour is removable. It may

not be until you are actually on the operating

table that it is discovered that the tumour

cannot be removed.

What happens before the operation?

Once surgery has been agreed with you as the

favoured option, you will be asked to attend a pre-

assessment clinic to assess your fitness for surgery

and answer questions.This usually takes half a day;

during this, the operation will be explained in detail

and informed consent will be taken from you for

the procedure.An anaesthetist will explain the

anaesthetic process and discuss the post-operative

pain relief options.This is usually in the form of

epidural analgesia, where a small tube is inserted

into your back to deliver the pain relieving drugs.

Alternatively, a patient control analgesia pump (or

PCA) will be offered.A PCA allows you to control

your own dosage of pain relief, delivered through

a drip in your arm, by pressing a small button.

Please use this opportunity to ask the surgeons,

nurses or anaesthetists any questions that you have.

On admission, you will be given information about

the expected date of your discharge from hospital.

This is to help you, and the staff caring for you, to

plan and prepare for your return home.

The day before the operation, you must not eat

or drink anything after midnight as your stomach

needs to be as empty as possible for the general

anaesthetic you will be given for this operation.This

may be given to you when you are in the operating

theatre itself, so don’t worry if you are still awake

when you are first taken into the theatre.

A liver resection is an

operation to remove a part

of your liver. It is usually

performed because the liver

has one or more tumours in

it.The liver is one of the few

organs in the body that is able

to re-grow. Up to 80% of the

liver can be removed, and the

healthy liver will re-grow in

approximately 8-12 weeks.

If you have any further queries, please do not

hesitate to contact me on:

020 7234 2730

Mr Parthi Srinivasan, Consultant Liver and

Pancreatic Surgeon, London Bridge Hospital.