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Sunday, January 20, 2008

During Surgery

  • Getting the Go-Ahead
When that important phone call comes, the patient should make sure to bring the following to the hospital:
  1. A list of all the medications the patient is taking
  2. A list of the patient's drug allergies, if he has any
  3. The patient's health insurance information
IMPORTANT: As soon as a liver is available, the patient should stop all eating and drinking immediately. The patient's stomach must be empty when he is taken into the operating room.

  • At the Hospital
After admission, the patient will have a thorough physical examination, including more blood work, a chest x-ray, and EKG, and, possibly, other tests.
Unfortunately, surgery must be postponed in some cases. The patient will be sent home again if:
  1. he has an infection or has developed any other medical problem that would interfere with surgery or recovery
  2. The donor liver shows signs of deterioration or poor function
If surgery is postponed, the transplant team can help the patient through the disappointment. This is only a temporary setback, and the search for a new liver will go on.
  • Preparing the Patient for Surgery
The patient may receive an enema to clean out his intestines and prevent constipation after Surgery. His chest and abdomen will be shaved clean to prevent infection, and an intravenous (IV) line will be inserted in his arm or just under his collarbone to give medication and keep him from getting dehydrated. The patient will also be given a sedative to help him relax and feel sleepy before going to the operating room.


Because transplantation is a major surgical procedure, the patient may need a transfusion. Today, all blood is screened very carefully; the likelihood of contracting a disease is very small. Any concerns that the patient has regarding the source of the blood should be relayed to the transplant team during the waiting period, before getting to the hospital. Most hospitals offer the option of "autotransfusion" - this is when the patient donates his own blood before surgery. His own blood is stored and then used during transplantation.
  • Liver Transplant Surgery Procedure
The patient will be under general anesthesia throughout the surgery. Once asleep, the transplant surgeon will make an incision shaped like a boomerang on the upper part of the abdomen. The surgical team will then remove the patient's old liver, leaving portions of his major blood vessels in place. The new liver will then be inserted and attached to these blood vessels and to the patient's bile ducts. To help with bile drainage, a tube will also be inserted in the bile duct during surgery.
  • T-Tube Placement and Bile Drainage
During liver-transplant surgery, the surgeon may find it necessary to place a small tube, called a T-tube, into the bile duct. The T-tube allows bile to drain out of the patient's body into a small pouch, known as a bile bag. The amount of bile, which varies in color from deep gold to dark green, can then be measured. If a T-tube is put in place, it may remain attached to a bile bag for a week or possibly longer. When the bile bag is removed the T-tube will be tied or capped. It will remain in place for several months so that it can be used for special testing.
The T-tube is attached to the skin with a stitch. The dressing around the tube should be changed at least once daily, and more often if it becomes moist. The transplant nurse will show the patient how to change the dressing without pulling out the T-tube.
Other drains may be in the patient's abdomen during the postoperative period. A common name for these drains is Jackson-Pratt (JP). They are used to drain fluid from around the liver. Generally, these drains are removed before the patient goes home.

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