Liver Resection (Hepatectomy) Explained for Patients

What is a Liver Resection?

Liver resection, also known as a **hepatectomy**, is a surgery to remove part of the liver. This procedure is often used to treat liver cancer or tumors that have spread to the liver (such as colorectal liver metastases). The liver has a unique ability to regenerate, meaning it can grow back after part of it is removed.

Why is it Done?

Liver resection is performed when cancer is confined to one part of the liver, and removing the affected section can stop the spread of the disease. It’s used to treat conditions like:

- Hepatocellular carcinoma (HCC), the most common form of liver cancer.

- Colorectal liver metastasis (CRLM), where cancer from the colon or rectum spreads to

the liver.

- Cholangiocarcinoma, a rare bile duct cancer that can affect the liver

What Happens During the Surgery?

1. Preparation: The surgery is performed under general anesthesia, meaning the patient will be asleep throughout the operation.

2. Incision: The surgeon makes an incision in the abdomen to access the liver. In some cases, the procedure can be performed laparoscopically, using smaller incisions and a camera.

3. Resection: The surgeon carefully identifies and removes the diseased part of the liver. This may involve removing a segment, lobe, or a larger portion of the liver, depending on the location and size of the tumour.

4. Control of Blood Vessels: The liver has a rich blood supply, so the surgeon will carefully control the blood vessels to prevent bleeding during the operation.

5. Closure: After removing the affected portion, the surgeon closes the incision with stitches or staples.

Recovery and Post-Surgery Care

Hospital Stay: Most patients stay in the hospital for 5-7 days after a liver resection. Monitoring is necessary to ensure proper healing and liver function.

Regeneration: The liver will start to regenerate soon after surgery, and in many cases, it can grow back to near its original size within a few months

Risks: Like any major surgery, liver resection carries some risks, including infection, bleeding, and bile leakage. However, it is generally a safe and effective treatment for localised liver cancers

Overall: Liver resection is a crucial treatment for various liver conditions, offering patients a chance at long-term recovery. Although the surgery can be complex, the liver’s regenerative capacity makes it possible for many patients to resume normal life after recovery.

Liver Cancers

Colorectal Liver Metastasis (CRLM)

What is Colorectal Liver Metastasis?

Colorectal liver metastasis occurs when cancer from the colon or rectum spreads to the liver. This is the most common site of metastasis for colorectal cancer because of the liver’s role in filtering blood from the digestive tract. Early detection and treatment are crucial for a positive outcome.

Symptoms of CRLM

Often, CRLM causes no symptoms until the disease progresses. However, as tumors grow, symptoms may include:

• Abdominal pain or discomfort

• Fatigue or weakness

• Jaundice (yellowing of the skin and eyes)

• Weight loss

• Loss of appetite

Treatment Options

Surgical Resection: Removing part of the liver where the tumors are located. This is the preferred treatment when the metastases are limited and surgically removable.

Ablation: For smaller tumours, heat or cold can be used to destroy cancer cells.

Chemotherapy: Sometimes used before or after surgery to shrink tumors or prevent recurrence.

Hepatocellular Carcinoma (HCC)

What is Hepatocellular Carcinoma?

Hepatocellular carcinoma is the most common type of primary liver cancer, often arising in individuals with chronic liver diseases like cirrhosis or hepatitis B or C. Early-stage HCC can often be treated with surgery, but advanced cases may require additional therapies.

Symptoms of HCC

In the early stages, HCC may not cause symptoms, but as the cancer grows, patients may experience:

• Upper right abdominal pain

• Jaundice

• Unexplained weight loss

• Nausea or vomiting

• A swollen abdomen due to fluid buildup (ascites)

Treatment Options

Surgical Resection: Removing the cancerous part of the liver.

Liver Transplant: If the tumor is small and meets certain criteria, a liver transplant may be an option.

Ablation or Embolisation: Used for smaller tumors or in patients who cannot undergo surgery. These treatments destroy the tumor or block its blood supply

Cholangiocarcinoma (Bile Duct Cancer)

What is Cholangiocarcinoma?

Cholangiocarcinoma is a rare cancer that forms in the bile ducts, which carry bile from the liver to the gallbladder and small intestine. It is typically more difficult to treat because it is often diagnosed at a later stage.

Symptoms of Cholangiocarcinoma

• Jaundice: Yellowing of the skin and eyes

• Itchy Skin: Due to bile buildup

• Abdominal Pain: Often in the right upper quadrant

• Dark Urine and Pale Stools

• Unexplained Weight Loss

Treatment Options

• Surgical Resection: Removing the cancer if it is caught early and is operable.

• Liver Transplant: In select cases, for early-stage cholangiocarcinoma.

• Chemotherapy/Radiation: These are often used to control the disease or as palliative treatment for advanced cases.

What Patients Should Do After Surgery?

For liver cancer surgery, whether it’s for CRLM, HCC, or cholangiocarcinoma, recovery care is essential. Here's what patients can expect and what they should do post-surgery:

1. Rest and Recovery

• Patients will need to rest after surgery, with gradual increases in activity. The recovery time can vary, but it often takes 4-8 weeks to return to full activity after liver resection

• Avoid heavy lifting or strenuous exercise during this period.

2. Managing Pain

• Post-surgery pain can be managed with medications prescribed by the doctor. Soreness around the incision sites is common, especially if a large portion of the liver was removed.

• Walking is encouraged to prevent blood clots, but patients should move at a comfortable pace

3. Diet

• Patients may need to start with a light diet (soups, broths, and soft foods) and gradually return to normal meals. It’s important to maintain a healthy diet to help the liver regenerate and heal.

• Stay hydrated, and avoid alcohol or overly fatty foods, as these can strain the liver.

4. Follow-Up Care

• Routine follow-up appointments are necessary to monitor liver function and check for any signs of cancer recurrence. Blood tests and imaging (CT scans, MRIs) are commonly used in post-surgery follow-up.

• Discuss any persistent symptoms such as jaundice, abdominal pain, or weight loss with your doctor immediately.

5. When to Call the Doctor

Contact your doctor if you experience fever, increasing pain, jaundice, or signs of infection around the incision site.

Abdominal Hernias

Inguinal Hernias

What is an Inguinal Hernia?

An inguinal hernia occurs when a portion of the intestine or fatty tissue pushes through a weak spot in the abdominal muscles, typically in the groin area. This is the most common type of hernia, especially in men.

Symptoms

• A visible bulge in the groin or scrotum

• Pain or discomfort, especially when lifting, coughing, or bending

• A feeling of heaviness or weakness in the groin

Treatment Options

• Laparoscopic Hernia Repair: A minimally invasive surgery that involves making small incisions and using a laparoscope to push the hernia back into place and reinforce the weakened area with a mesh.

• Open Hernia Repair: A larger incision is made in the groin, and the hernia is repaired using sutures or mesh.

Umbilical Hernias

What is an Umbilical Hernia?

An umbilical hernia occurs when part of the intestine or fat tissue pushes through a weak spot in the abdominal muscles near the belly button. It is most common in infants but can also affect adults.

Symptoms

• A soft bulge or swelling near the belly button

• Discomfort or pain in the belly button area, especially when coughing or lifting heavy objects

• The bulge may increase in size when standing or straining

Treatment Options

• Laparoscopic or Open Surgery: The surgery involves pushing the hernia back into place and reinforcing the area with stitches or mesh to prevent recurrence

Incisional Hernias

What is an Incisional Hernia?

An incisional hernia can occur at the site of a previous surgical incision. After an abdominal surgery, the muscles in the area may become weakened, allowing part of the intestine or tissue to push through.

Symptoms

• A bulge or lump near the area of a previous surgery

• Pain or discomfort around the surgical site

• Symptoms may worsen with physical activity or strain

Treatment Options

Laparoscopic Repair: Small incisions are made to repair the hernia using a mesh for reinforcement.

Open Repair: A larger incision may be necessary for bigger hernias, particularly in cases of recurrence.

After surgery for an inguinal, umbilical, or incisional hernia, patients should follow a recovery plan to ensure proper healing. Here’s what to expect and what to do:

Immediately After Surgery

• Rest and Recovery

• Rest is important for the first few days after surgery. You may feel tired and sore at the incision site, but walking around gently can help improve circulation and prevent blood clots.

• Avoid strenuous activities like heavy lifting, bending, or intense exercise for several weeks, depending on your surgeon’s advice.

• Pain Management

You may experience some discomfort or pain after surgery, which can be managed with prescribed painkillers like ibuprofen or paracetamol. Follow your surgeon’s instructions about which medications to take.

Some patients might also experience gas pain, especially after laparoscopic surgery, as air is used to inflate the abdomen during the procedure.

Caring for the Incision

• Keep the surgical site clean and dry. You will likely have small, dissolvable stitches and bandages over the incisions.

• Follow your doctor’s instructions on when it is safe to shower, typically 24-48 hours after surgery.

• Avoid soaking in baths or swimming pools until your incisions have fully healed

Diet

• You can generally resume a normal diet after surgery, but it’s a good idea to start with light, easily digestible foods for the first day or two. Stay hydrated and avoid heavy, greasy meals that could upset your stomach.

• If you had an umbilical hernia repair or incisional hernia surgery, some doctors recommend a high-fibre diet to avoid constipation, which can strain the repaired area.

Exercise and Activity

• Light walking is encouraged shortly after surgery to aid circulation and speed recovery. However, avoid heavy lifting, vigorous exercise, or straining for 4-6 weeks, as these activities can put pressure on the surgical site and risk recurrence of the hernia.

• Gradually increase your activity level as advised by your doctor

When to Call Your Doctor

• Infection Signs: If you notice redness, swelling, increasing pain, or discharge from the incision site, contact your surgeon, as this could indicate an infection.

• Fever: A high fever or chills could be a sign of infection.

• Swelling or Pain: While some discomfort is normal, persistent or severe pain, or bulging at the surgical site, could indicate complications.

Returning to Work

Most patients can return to work within 1-2 weeks, depending on the type of surgery (laparoscopic or open) and the nature of their job. Those with physically demanding jobs may need a longer recovery period before resuming full duties

Follow-Up Appointments

Attend any scheduled follow-up appointments to ensure proper healing and to address any concerns. Your surgeon will check the incision and make sure the hernia has been effectively repaired.

By following these guidelines, patients can recover smoothly and reduce the risk of complications. Always check with your surgeon for specific instructions tailored to your surgery and personal health.

Liver Cysts Overview

What Are Liver Cysts?

Liver cysts are fluid-filled sacs that form in the liver. Most liver cysts are benign (non-cancerous) and don’t cause symptoms, but occasionally, they may grow large enough to cause discomfort. They are usually found during imaging tests, like an ultrasound or CT scan, performed for other reasons.

Types of Liver Cysts:

1. Simple Cysts: These are the most common type and are typically harmless.

2. Polycystic Liver Disease (PLD): This condition causes multiple cysts to form and may be linked with kidney cysts.

3. Hydatid Cysts: Caused by a parasitic infection (Echinococcus), these cysts require treatment to prevent complications.

4. Biliary Cysts: These can block bile flow and may need surgical removal

Symptoms of Liver Cysts:

Most liver cysts do not cause symptoms. However, if a cyst becomes large, you may experience:

• A feeling of fullness or discomfort in the upper right abdomen

• Pain in the upper right side of the abdomen

• Bloating or nausea

Diagnosis of Liver Cysts:

Liver cysts are often discovered incidentally during imaging tests. If a cyst appears suspicious, your doctor may recommend additional imaging or blood tests to determine if treatment is necessary.

Treatment of Liver Cysts:

When Is Treatment Needed?

Most liver cysts do not require treatment unless they are causing symptoms. If a cyst grows large or becomes painful, your doctor may suggest draining it or removing it surgically.

Surgical Options:

• Laparoscopic Cyst Removal: This is a minimally invasive procedure where the surgeon makes small incisions to remove the cysts using special tools. It’s often done if the cyst is causing pain or is large

• Drainage: Sometimes, if the cyst is filled with fluid, it can be drained using a needle and ultrasound guidance. However, this is often a temporary solution as cysts may refill

Long-Term Outlook:

For most people, liver cysts do not cause long-term problems. Once removed, simple cysts typically do not come back, and patients can return to normal activities soon after surgery.

Long-Term Outcomes After Laparoscopic Cholecystectomy

After laparoscopic gallbladder removal, most patients experience significant relief from symptoms caused by gallstones, such as pain, nausea, and digestive discomfort. However, there are some long-term changes and potential outcomes to be aware of:

1. No Major Changes to Digestion

The gallbladder stores bile, which helps digest fats. After its removal, bile flows directly from the liver into the intestines. Most people can digest food normally without a gallbladder, but some may notice mild changes in digestion, such as:

• Diarrhoea or Loose Stools: A small number of people may experience looser or more frequent stools, especially after eating fatty meals. This typically resolves within a few weeks or months but may persist longer for some.

• Fat Tolerance: While most can return to a regular diet, a few may find that large, fatty meals cause discomfort or loose stools in the long term. Managing fat intake can help.

2. Reduced Gallstone-Related Symptoms

The surgery effectively prevents further issues with gallstones, such as biliary colic, cholecystitis (gallbladder inflammation), and pancreatitis caused by gallstones.

3. Rare Long-Term Complications

• Post-Cholecystectomy Syndrome: A small number of patients may continue to experience symptoms like abdominal pain, bloating, and indigestion even after surgery. This is known as post-cholecystectomy syndrome, which may occur due to bile leakage or stones left in the bile duct.

• Bile Reflux: In rare cases, bile may flow back into the stomach, causing discomfort and a burning sensation, known as bile reflux.

4. Dietary Adjustments

Most people adapt well to eating normally again after surgery, but if digestive issues persist, small, frequent meals and a lower-fat diet may help reduce symptoms like bloating and diarrhoea.

Overall Long-Term Outlook

For the vast majority of patients, laparoscopic cholecystectomy provides long-lasting relief from gallstone-related issues, with minimal disruption to daily life. Most return to full activity and normal eating within weeks and experience significant improvements in quality of life.

It’s always important to discuss any ongoing symptoms or dietary concerns with your surgeon after surgery to ensure the best possible recovery.

After Laparoscopic Cholecystectomy: What to Expect

After the surgery, most patients recover quickly and can return to normal life in a few weeks. Here’s what to expect:

Immediately After Surgery

• Hospital Stay: Most people can go home the same day (day case), though some may stay overnight, especially if there were any complications or if they are feeling unwell.

• Eating and Drinking: You can usually start drinking liquids a few hours after surgery. A light meal can be consumed later the same day. Gradually reintroduce solid food, but it’s advisable to avoid fatty, greasy foods for a few days.

Pain and Discomfort

• Incision Pain: You may experience some soreness at the incision sites, which will improve over a few days. The stitches are dissolvable, and the dressings can be removed after about a week

• Gas Pain: Some patients feel shoulder pain after surgery due to the gas used during the procedure. This should resolve within 24-48 hours

Returning to Normal Activity

• Work and Daily Activities: Most people can resume light activities within 1-2 weeks. You may need to wait 4 weeks before engaging in more strenuous activities like heavy lifting

• Exercise: Light walking is encouraged soon after surgery to help prevent blood clots, but avoid intense exercise for at least two weeks

Full Recovery

• Recovery Time: Full recovery typically takes about 2 weeks for most patients. If the surgeon had to switch to open surgery, recovery may take longer, usually around 4-6 weeks

Diet Changes

• Initially, stick to light, low-fat meals to avoid upsetting your digestive system. Over time, you can resume a normal diet. Without a gallbladder, bile will drip continuously into your digestive system, and some people might experience loose stools temporarily.

.

Follow-Up

• Your doctor will likely schedule a follow-up appointment to check the incisions and ensure you are healing properly. This may be 1-2 weeks after the surgery.

Signs to Watch For

While complications are rare, contact your doctor if you experience:

• Fever or chills

• Persistent pain or swelling around the incision sites

• Jaundice (yellowing of the skin or eyes)

• Nausea or vomiting that doesn’t improve..

Most patients find that after a laparoscopic cholecystectomy, their symptoms improve dramatically, and they can return to a normal lifestyle quite quickly.

Risks of Laparoscopic Cholecystectomy

Like any surgery, laparoscopic cholecystectomy carries some risks, although serious complications are rare. Here’s what you should be aware of:

1. Shoulder Pain: After the operation, you may experience shoulder tip pain due to the gas used to inflate the abdomen. This is common and typically goes away within 24 hours

2. Infection: There is a small risk of infection at the incision sites or internally. Signs of infection include redness, swelling, or discharge at the wound site, as well as fever

3. Bleeding: As with any surgery, there’s a risk of bleeding, which might require a blood transfusion, especially if you’re on blood-thinning medications.

4. Bile Duct Injury: In about 1 in 300 cases, the bile duct may be accidentally injured, which can lead to bile leakage or blockage. This might require additional surgery to correct

5. Blood Clots (DVT/PE): Blood clots can develop in the legs (deep vein thrombosis) or lungs (pulmonary embolism), though this risk is reduced by using anti-embolism stockings during surgery.

6. Retained Stones: Sometimes a gallstone may be left in the bile duct even after surgery, which could require another procedure to remove it.

7. Conversion to Open Surgery: In about 3-5% of cases, the surgeon may need to switch from a laparoscopic procedure to open surgery if complications arise, like excessive scarring or difficulty accessing the gallbladder

While these risks exist, laparoscopic cholecystectomy is generally very safe, and most patients recover without any major issues.. Always consult your surgeon to discuss any personal risk factors before surgery.

Laparoscopic Cholecystectomy Explained

Laparoscopic cholecystectomy is the most common procedure for removing the gallbladder when gallstones cause symptoms. It’s a minimally invasive surgery that uses small incisions and is often preferred due to its quicker recovery time compared to traditional open surgery.

How Is It Done?

1. Small Incisions: The surgeon makes four tiny incisions (5-10mm) in your abdomen.

2. Camera and Instruments: A laparoscope (a thin tube with a camera) is inserted through one incision to give the surgeon a clear view of your gallbladder on a screen. Through the other incisions, small surgical tools are inserted.

3. Gallbladder Removal: The gallbladder is carefully detached from its connections to the liver and bile duct. The surgeon removes the gallbladder through one of the small incisions.

4. Closing the Incisions: The incisions are closed with dissolvable stitches, and the procedure usually takes about 45 minutes to 1 hour.

Recovery

• Most patients go home the same day and can resume normal activities within 1 to 2 weeks.

• You may experience some shoulder pain from the gas used to inflate your abdomen, but this should resolve within a day.

Benefits

• Smaller scars

• Shorter hospital stay

• Faster recovery time

This approach is highly effective, and most people experience relief from gallstone-related symptoms once the gallbladder is removed.

Gallstones: An Overview

What Are Gallstones?

Gallstones are hard, pebble-like pieces that form in the gallbladder, a small organ beneath the liver. These stones are primarily made up of cholesterol or bile pigments. Many people with gallstones experience no symptoms; however, if the stones block the flow of bile, it can lead to painful complications.

Symptoms of Gallstones:

While some people may not experience any symptoms, others may notice:

• Sudden, sharp pain in the upper right side of the abdomen (biliary colic), often after eating fatty foods

• Nausea and vomiting

• Indigestion or a feeling of fullness

• Fever and jaundice (yellowing of the skin), which may indicate a more serious condition

Risk Factors:

Gallstones are more common in people who are:

• Over 40 years old

• Overweight

• Female (especially after pregnancy)

• Rapidly losing weight

• Taking certain medications like hormone replacement therapy or birth control pills

Treatment Options:

If gallstones cause symptoms, the most common treatment is surgery to remove the gallbladder, called a **laparoscopic cholecystectomy**. This is a minimally invasive procedure where small incisions are made to remove the gallbladder. You can live a healthy life without your gallbladder, as bile will still flow from your liver to your intestines. Recovery usually takes about two weeks.