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Surgery - Liver Resection
Indications
Elective: Liver tumors: primary and secondary, benign and malignant.
Guidelines regarding colorectal metastases: liver disease that can be completely removed with a resection margin of greater than 5 mm, leaving at least three normal liver segments (or more if cirrhosis), solitary or metastases restricted to a localized area of the liver, without extrahepatic disease or limited to resectable local recurrence.
Infections: Some infections, such hydatid cysts, may require excision.
Live-related liver donation is removing a portion of the donor's liver and transplanting the recipient with the removed liver.
Trauma in an emergency if measures like packing, suture ligation, or bimanual compression have not been able to stop the bleeding (resectional debridement of devitalized liver tissue, for example).
Anatomy
The liver is divided into eight segments (of Couinaud), each with its own branches of the arterial, venous, and biliary systems. The liver has four lobes: the right, left, quadrate, and caudate (the latter two physically part of the right lobe but functionally part of the left). I through VIII are their numbers (from left to right). Segmental or nonsegmental resections are possible. Normal humans can regenerate up to 70% of their body, which is consistent with survival.
Vascular supply: The portal vein (70%) and hepatic artery (30%) each supply 1.5 liters of blood per minute to the liver. The inferior vena cava receives the three hepatic veins that are formed by venous flow.
Investigational studies
Patients must be chosen based on stringent qualifying requirements.
Imaging: USS, CT, and MRI may be required for resection planning and staging.
Liver function before to surgery: As an illustration, children–Pugh grading (based on prothrombin time, bilirubin, albumin, and the presence of ascites or encephalopathy): because of the small reserve of the remnant cirrhotic liver, cirrhosis prevents major resections.
Blood: LFT, clotting, U&Es, and FBC.
Blood-based products: Before surgery, blood and FFP should be cross-matched because to the increased risk of bleeding and the need for transfusions.
Actions
should only be completed in facilities with the necessary expertise as specialists.
Rooftop incisions or increasingly laparoscopic procedures are used for incisions.
Investigation: Using intraoperative ultrasound, a tumor's boundaries and the extent to which it has affected nearby structures (such as the biliary tree and arteries) can be determined.
Vascular occlusion: Two methods are used to temporarily obstruct the inflow into the liver: either the Glisson's capsule of the segment is selectively clamped, or a tourniquet is placed around the portal triad (Pringle's technique, up to 20 min).
Liver resection: A variety of procedures, such as the use of an ultrasonic dissector and harmonic scalpel to carefully ligate sutures or cut arteries or ducts, can be used to achieve parenchymal transaction. Lastly, a thorough inspection for bleeding or bile leakage should be performed on the resection surface.
Closure of the liver: Resection surfaces can be sealed using fibrin adhesive or a collagen sponge.
Complications
bleeding, liver failure, biliary or peritonitis-related sepsis, and related pulmonary problems (such as pleural effusion).
Indications
Elective: Liver tumors: primary and secondary, benign and malignant.
Guidelines regarding colorectal metastases: liver disease that can be completely removed with a resection margin of greater than 5 mm, leaving at least three normal liver segments (or more if cirrhosis), solitary or metastases restricted to a localized area of the liver, without extrahepatic disease or limited to resectable local recurrence.
Infections: Some infections, such hydatid cysts, may require excision.
Live-related liver donation is removing a portion of the donor's liver and transplanting the recipient with the removed liver.
Trauma in an emergency if measures like packing, suture ligation, or bimanual compression have not been able to stop the bleeding (resectional debridement of devitalized liver tissue, for example).
Anatomy
The liver is divided into eight segments (of Couinaud), each with its own branches of the arterial, venous, and biliary systems. The liver has four lobes: the right, left, quadrate, and caudate (the latter two physically part of the right lobe but functionally part of the left). I through VIII are their numbers (from left to right). Segmental or nonsegmental resections are possible. Normal humans can regenerate up to 70% of their body, which is consistent with survival.
Vascular supply: The portal vein (70%) and hepatic artery (30%) each supply 1.5 liters of blood per minute to the liver. The inferior vena cava receives the three hepatic veins that are formed by venous flow.
Investigational studies
Patients must be chosen based on stringent qualifying requirements.
Imaging: USS, CT, and MRI may be required for resection planning and staging.
Liver function before to surgery: As an illustration, children–Pugh grading (based on prothrombin time, bilirubin, albumin, and the presence of ascites or encephalopathy): because of the small reserve of the remnant cirrhotic liver, cirrhosis prevents major resections.
Blood: LFT, clotting, U&Es, and FBC.
Blood-based products: Before surgery, blood and FFP should be cross-matched because to the increased risk of bleeding and the need for transfusions.
Actions
should only be completed in facilities with the necessary expertise as specialists.
Rooftop incisions or increasingly laparoscopic procedures are used for incisions.
Investigation: Using intraoperative ultrasound, a tumor's boundaries and the extent to which it has affected nearby structures (such as the biliary tree and arteries) can be determined.
Vascular occlusion: Two methods are used to temporarily obstruct the inflow into the liver: either the Glisson's capsule of the segment is selectively clamped, or a tourniquet is placed around the portal triad (Pringle's technique, up to 20 min).
Liver resection: A variety of procedures, such as the use of an ultrasonic dissector and harmonic scalpel to carefully ligate sutures or cut arteries or ducts, can be used to achieve parenchymal transaction. Lastly, a thorough inspection for bleeding or bile leakage should be performed on the resection surface.
Closure of the liver: Resection surfaces can be sealed using fibrin adhesive or a collagen sponge.
Complications
bleeding, liver failure, biliary or peritonitis-related sepsis, and related pulmonary problems (such as pleural effusion).
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