Background Information:

What are the other Names for the Procedure?

• Hepatectomy (Partial or Total)
• Liver Removal (Partial or Total)
• Removal of Liver (Partial or Total)

What is Liver Resection surgical procedure?

Liver Resection is a surgical procedure that involves the removal of a part of the liver. It is also known as Hepatectomy (Partial or Total).

What part of the Body does the Procedure involve?

The Liver Resection procedure involves the abdominal cavity, liver, and gallbladder.

Why is the Liver Resection surgical procedure Performed?

A Liver Resection or Removal of Liver (either partial or total) is performed for the following reasons:

• Removal of suspected cancerous tumor within a liver
• Stop excessive bleeding within a severely damaged liver 

What are some Alternative Choices for the Procedure?

Some types of cancers can be surgically removed; for such tumors, no other alternative procedures exist.

What are the Recent Advances in the Procedure?

Liver Resections may be performed using laparoscopic (minimally invasive) techniques.

What is the Cost of performing the Liver Resection surgical procedure?

The cost of Liver Resection surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Liver Resection surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.surgery.com/procedure/hepatectomy (accessed on 07/30/2014)

http://www.med.unc.edu/surgery/education/files/articles/Liver,%20biliary%203.pdf (accessed on 07/30/2014)

http://www.openanesthesia.org/Liver_Surgery (accessed on 07/30/2014)

Prior to Liver Resection surgical procedure:

How is the Liver Resection surgical procedure Performed?

• The Hepatectomy procedure is carried out under general anesthesia
• Depending on the amount of liver tissue that is removed, the procedure may be either partial (involving a portion of the liver) or total. This is called Partial or Complete Liver Removal
• The surgeon first makes an incision over the skin of the upper abdomen on the right side, along and just below the rib cage. This is then extended upwards a little in the midline. Further extension of the incision to below the left rib cage may also be made, if needed
• The surgeon then cuts the fibrous tissue attached to the liver, in order to free it
• After clamping-off the blood vessels that feed the portions to be removed, the surgeon then cuts and removes the affected liver segments
• In cases where transplantation is indicated, the surgeon may remove the diseased liver completely
• After ensuring that there is no bleeding, the surgeon then closes the abdominal wound in layers

Where is the Procedure Performed?

A Liver Resection procedure is performed at a hospital.

Who Performs the Procedure?

A general surgeon, a liver transplant surgeon, or a vascular surgeon, performs the Liver Resection surgical procedure.

How long will the Procedure take?

A Liver Resection procedure can take anywhere between 3-4 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the liver resection surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Liver Resection (Hepatectomy) procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Liver Resection Surgical procedure?

Before a Liver Removal (Partial or Total) procedure, the patient has to undergo certain tests, such as:

• Blood test to assess overall body status and specifically liver function
• Chest x-ray
• Electrocardiography (ECG)
• Ultrasound scan of abdomen
• Computerized tomography (CT scan) of abdomen
• Liver biopsy

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Liver Resection surgical procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Liver Resection surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered prior to the Hepatectomy procedure.

How much Blood will you lose, during the Procedure?

The liver has abundant blood supply and hence significant blood loss may occur during the Liver Resection procedure. An average loss of around 600 milliliters may be expected.

What are the possible Risks and Complications during the Liver Resection surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Removal of Liver (Partial or Total) surgery are:

• Excessive bleeding
• Infection surrounding the surgical would
• Anesthetic complications
• Accidental injury to major blood vessels, such as the vena cava, or to other neighboring organs surrounding the liver/kidney

What Post-Operative Care is needed at the Healthcare Facility after the Liver Resection surgical procedure?

• After the Liver Resection surgical procedure, patients will be sent to an area of the hospital called postoperative recovery area or PACU
• The patient’s blood pressure, heart rate, and respiration cycle will be closely monitored. Any additional pain associated with the procedure will also be treated
• Individuals are usually discharged from the hospital 7-10 days, after the surgery is performed

After the Liver Resection surgical procedure:

What are the possible Risks and Complications after the Liver Resection surgical procedure?

Post Liver Resection procedure the possible complications that may arise are:

• Excessive bleeding
• Infection in the surgical wound
• Excessive bleeding from other part of the liver
• Liver failure
• Kidney failure
• Incisional hernia
• Decreased circulation of blood to the remaining part of the liver
• Abnormal and extended leakage of the bile duct system

What is the Prognosis after the Surgery?

• A complete recovery from a Liver Resection procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted, in a majority of the cases
• However, older individuals may take longer to fully recover from a Liver Resection procedure

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling surrounding the surgical wound
• Bleeding or fluid drainage from around the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, abnormal swelling within the abdomen, and prolonged constipation
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches
• Headaches
• Jaundice (yellowing of the eyes)
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Liver Resection surgical procedure?

At home, the following post-operative care is recommended, after a Liver Resection procedure:

• Slowly resume regular/daily activities as early as possible, which aids in a faster recovery. The physician may advise individuals to take regular naps during the day, if they feel tired
• Use a heat pad or warm compress, to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with a mild soap
• Replace the dressing on the surgical wound, after showering
• Compression stockings should be worn for the first few weeks after the procedure
• Complete the course of prescribed medication, as advised by your physician
• Avoid taking nonprescription medications, such as aspirin.  However, individuals may take acetaminophen to relieve pain, if required (under advice by the physician)
• Vitamin or mineral supplements may be prescribed by the physician
• Avoid all activities that are physically strenuous for about 6-8 weeks after surgery
• Avoid sex till a complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 8-12 weeks to fully recover from a Liver Resection procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Liver Resection surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist
• A general surgeon or a vascular surgeon

The patient is advised to inquire and confirm the type of billing, before the Liver Resection is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA