Liver Surgery

Structure and Function of the Liver

The liver is the most important storage and detoxification organ in our body. The organ, which weighs about 1.5 kg, is located in the right upper abdomen, directly below the diaphragm, divided into two liver lobes and a total of 8 liver segments.

All the blood that has absorbed food components and harmful substances, dead cells, digestive enzymes, etc., in the stomach, intestines, spleen, and pancreas passes through the portal vein into the liver. This, in turn, can eliminate toxic substances through the bile it produces, store sugars and fats, or reassemble them if necessary. t is also responsible for the synthesis of blood clotting factors.

The liver has an excellent regenerative capacity. t can form many new healthy liver cells from a small amount of healthy liver tissue. Nevertheless, some diseases damage the liver and, in the course, require liver surgery.

For Which Diseases Can Liver Surgery Become Necessary?

The following benign and malignant liver diseases and biliary tract diseases, among others, are operated on by liver surgeons:

• Liver abscess
• Liver cysts
• Echinococcosis
• Hemangiomas
• Liver adenomas
• Liver cancer
• Cholangiocellular carcinoma
• Liver metastases

Which Liver Surgeries Are Available, and When Are They Used?

Before any surgical procedure, a detailed diagnostic evaluation is performed. This allows the visceral surgeon to gather all the necessary data required for liver surgery and plan the surgery in the best possible way.

Minor procedures, such as placing an irrigation catheter (a plastic tube through which pus can drain) in the case of a liver abscess, are carried out under local anesthesia.

The visceral surgeon can usually remove liver cysts (fluid-filled blisters) through laparoscopy or an open abdominal incision by cutting them open and suctioning them out. The mucosal coating layer is removed, and the hole is covered with the peritoneum, which prevents the cyst from forming again.

In echinococcosis cases, partial liver resection is sometimes necessary if the infestation is large. However, this is decided on an individual basis.

Benign liver adenomas are also usually removed by minimally invasive laparoscopy. For this purpose, the affected liver segment is accessed and removed through small incisions in the skin using special instruments and a camera

The therapy of malignant cancers such as liver cancer, bile duct cancer, and liver metastases often takes place in the synergy of different types of treatment.

For example, before tumor removal, the visceral surgeon may deprive the area affected by cancer of its blood supply, causing it to shrink. t the same time, healthy tissue is stimulated to grow. n this way, large tumors can be removed in certain cases without leaving enough functional liver tissue.

The donor organ is connected to blood vessels in the patient's body during liver transplantation. The surgery takes about 4-8 hours and involves lifelong immunosuppression to prevent the rejection of the donated organ.

What Are the Prognosis and Disease Progression After Liver Surgery?

Prognosis and disease progression depends significantly on the underlying disease and its spread.

Liver adenomas, for example, have an excellent prognosis after surgical removal. n rare cases, a new adenoma may appear over time, but it can be treated similarly.

Malignant cancers, on the other hand, have a poorer prognosis. For example, in the case of liver cancer, 30-50% of the patients are still alive after 5 years if the surgery was carried out in an experienced center for liver surgery.

However, due to the combination of different procedures (chemotherapy, radiotherapy, chemoembolization, surgery) and the excellent regenerative capacity of the liver, it has been possible in recent years to completely cure patients with significant liver tumors or liver metastases more often.

In any case, the visceral surgeon will discuss the options and alternatives in detail with an interdisciplinary team and, of course, with you before starting any therapy.

If you have any further questions regarding the types and options of liver surgery, please feel free to contact your attending visceral surgeon with confidence.

Sources:

• http://www.internisten-im-netz.de/de_leber-haeufige-erkrankungen_853.html
• http://www.internisten-im-netz.de/de_leberkrebs-erste-anzeichen_1189.html
• http://www.lebertransplantation.eu/
• Henne-Bruns, Doris; Barth, Harald (2012): Chirurgie. 4., aktualis. Aufl. Stuttgart [u.a]: Thieme (Thieme Electronic Book Library)
• Herold, Gerd (2014): Innere Medizin. Eine vorlesungsorientierte Darstellung ; unter Berücksichtigung des Gegenstandskataloges für die Ärztliche Prüfung ; mit ICD-10 Schlüssel im Text und Stichwortverzeichnis. Köln: Herold