Hepatectomy - Surgery, Procedure Steps, Types, Results

Hepatectomy meaning in simpler terms is the surgical removal of a portion of the liver. Depending on the requirements of the procedure, it can be performed either laparoscopically or through an open approach. 

Anatomy and Physiology of the Liver

The liver is located in the upper right part of the abdomen. It gets blood via the hepatic artery and the hepatic portal vein. The organ is divided into two lobes, subdivided into thousands of small lobules. 

The liver performs numerous vital functions essential for maintaining overall health. Some of these include:

1. Detoxification: The liver filters and removes toxins from the blood.

2. Blood Clotting: It produces clotting factors necessary to prevent excessive bleeding.

3. Metabolism: The liver processes carbohydrates, proteins, and fats, converting them into energy.

4. Bile Production: It produces bile, a digestive fluid that breaks down fats in food.

5. Storage: The organ stores essential vitamins and minerals, releasing them into the bloodstream as needed.

Types of Hepatectomy

Each type of hepatectomy is selected based on the location, size, and severity of the liver disease and the patient’s overall health. The goal is to remove the damaged tissue while preserving healthy liver tissue.

Hepatic resection treats various malignant, precancerous, and benign tumours. These include the following: 

1. Hepatocellular Carcinoma: Excision of primary cancerous tumours from the liver. 

2. Metastatic Colorectal Surgery: A cancer treatment that has propagated to the liver from the colon or rectum. 

3. Cholangiocarcinoma: Extracting cancers originating in the bile ducts within the liver.

4. Intrahepatic Stones: Surgical removal of gallstones in the bile ducts inside the organ. 

5. Benign Liver Tumours: Removing non-cancerous growths, such as adenomas, that may cause symptoms or complications.

6. Liver Cysts: Treatment for symptomatic or large cysts that may result in pain or interfere with liver function.

Who needs hepatectomy? 

Hepatectomy may be necessary for individuals experiencing symptoms that indicate severe liver conditions. These physical manifestations can include:

1. Persistent pain in the abdomen 

2. Jaundice (yellowing of the eyes and skin because of liver dysfunction)

3. Tiredness and lack of energy

4. Loss of appetite 

5. Early satiety (feeling full quickly after eating small amounts of food)

6. Lump in the upper right abdomen 

The surgery is also performed for individuals who want to donate a part of their liver for living donor liver transplantation. 

The surgical removal of liver is called a hepatectomy. The laparoscopic technique offers various benefits over the traditional approach. The advantages of the procedure are as follows: 

1. Laparoscopic procedures use small incisions, which result in less scarring. 

2. Patients typically experience less post-operative pain compared to open surgery.

3. Shorter hospital stays and quicker recovery times allow individuals to return to normal activities sooner.

4. Minimally invasive techniques often result in less blood loss during surgery. 

5. Advanced imaging and instruments used in laparoscopic surgery provide surgeons with a clearer view and greater precision

Hepatectomy is a major procedure that requires thorough planning and careful coordination. Knowing what to expect before and on the day of surgery can help ease anxiety and streamline the process.

Before Hepatectomy 

Before a hepatectomy, patients undergo thorough evaluations to assess their eligibility for the surgery. The doctor provides detailed instructions regarding fasting, medication adjustments, and smoking cessation.

On the Day of Hepatectomy

On the day of hepatectomy, patients must provide mandatory consent and change into a hospital gown. An IV line is placed, and the patient is positioned supine reverse Trendelenburg.

The exact procedure of the liver resection surgery varies depending on the type of surgery. It usually takes about two to six hours to complete and involves the following steps: 

1. The patient is given general anaesthesia to ensure they are unconscious and pain-free throughout the surgery.

2. For open surgery, the surgeon makes a large incision across the abdomen. The surgeon makes four to six keyhole cuts if a patient has laparoscopic surgery. These are used to insert the camera and surgical instruments. 

3. They use an intraoperative ultrasound to confirm the location and extent of the diseased tissue.

4. The liver is exposed, and the blood flow is temporarily blocked using metallic clips or staplers to reduce the risk of bleeding. 

5. The surgeon removes the diseased part of the liver. For laparoscopic surgery, they make an additional incision of 2 to 5 inches to extract the resected liver. 

6. The cut is closed with sutures or staples, and a dressing is placed over the wound.

Will the liver grow back after resection? Remarkably, the liver can regenerate, often restoring itself to its original size within four to six weeks after surgery. During this time, recovery involves careful monitoring and support to ensure proper healing and liver function.

In-Hospital Recovery 

Patients may need to stay in the hospital after the liver removal surgery for up to a week. They can expect the following during this time: 

1. Some patients may be shifted to an intensive care unit after surgery, where they stay for one or two days. 

2. The medical team closely monitors the individual’s vital signs, electrolyte balance, and blood loss. 

3. Once their condition stabilises, the patient is moved to a general ward or private room. 

4. The doctor prescribes pain medications to manage discomfort.  

5. Patients are allowed to drink fluids the next day after surgery. A normal diet is resumed over the next few months.

6. They are encouraged to move around to prevent blood clots. 

At-Home Recovery 

Recovery after a liver operation takes about four to eight weeks. The laparoscopic technique offers a quick recovery, lasting about two to four weeks. Guidelines to be followed at home are as follows: 

1. Take all prescribed medications as directed. 

2. Shower instead of bathing and pat dry the wound. 

3. Avoid heavy lifting or strenuous activities for six weeks after surgery. 

4. Quit smoking and alcohol. Adhere to any lifestyle changes recommended by the medical team.

Individuals can expect to resume normal activities 12 weeks after an open surgery and six to eight weeks after the laparoscopic method. 

First Follow-Up Appointment 

The doctor schedules the first follow-up appointment two weeks after surgery. During this visit, they assess the patient’s recovery and check for any signs of complications. They will also conduct blood tests to monitor liver function and detect any abnormalities. 

Hepatectomy is a major surgery that has certain risks and potential complications. Understanding these is crucial for patients considering the procedure

1. Bleeding: Due to the extensive blood supply of the liver, there is a significant risk of blood loss during and after surgery. 

2. Infection: Like any surgical procedure, infection can occur at the incision site or within the chest. 

3. Bile Leakage: Bile can leak from the liver or bile ducts, causing pain and fever. 

4. Ascites: It is the accumulation of fluid in the abdomen, which can lead to discomfort and the need for additional treatments. 

5. Blood Clots: Patients can develop these due to a lack of mobility after the surgery. If the blood clot becomes loose and travels through the bloodstream, it can cause serious complications like pulmonary embolism. 

6. Liver Failure: Removing a large portion of the liver can lead to this complication, especially if the remaining liver tissue is not healthy or sufficient.

When to call a doctor? 

After a left or right hepatectomy, patients should seek medical attention when they experience any concerning symptoms. These include the following: 

1. Persistent fever 

2. Unusual bleeding or discharge from the incision site 

3. Vomiting or diarrhoea 

4. Constipation for more than three days 

5. Swelling in the abdomen 

6. Jaundice (yellowing of the skin or eyes) 

Delaying a hepatectomy when it is medically indicated can cause several serious risks and complications. These are as follows:

1. Cancerous tumours can proliferate and metastasise, complicating their surgical removal. 

2. Symptoms such as pain, jaundice, and digestive issues can worsen over time, significantly impacting the patient’s quality of life.

3. As the disease progresses, the remaining healthy tissue may become insufficient to maintain normal liver function, leading to liver failure.

The liver surgery cost in India can vary depending on several factors. The price starts from ₹ 2 lakhs and goes up to ₹ 4.5 lakhs. The average expense of the procedure is ₹ 3.2 lakhs.

The following factors can affect the cost of hepatectomy: 

1. Surgeon’s Expertise: Specialists with more experience charge a higher fee.

2. Hospital Facilities: The cost differs between public and private hospitals, as well as the level of care and facilities provided.

3. Geographic Location: The procedure is costlier in metropolitan cities than in smaller towns. 

4. Post-operative Care: The length of hospital stay and the need for intensive care or additional treatments can increase expenses.

5. Insurance: The extent of coverage offered by health insurance can affect out-of-pocket expenses.

Hepatectomy is a surgical procedure that treats liver disease or tumours. While it carries certain risks, the benefits of removing diseased tissue often outweigh the potential complications. Timely intervention and proper post-operative care are crucial for a successful recovery.

HexaHealth provides access to top healthcare professionals. We offer detailed information about life expectancy after liver resection and help you understand your options. Our team ensures you receive personalised and effective care tailored to your needs.

See Also

• Fatty Liver
• Liver Cancer
• Liver Transplant
• Alcoholic Liver Disease
• Liver Hepatitis