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Saturday, November 1, 2008

LIVER TRANSPLANT SURGERY

LIVER TRANSPLANT SURGERY


During the operation, surgeons will remove your liver and will replace it with the donor liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward:
  • Liver transplant surgery is extremely complex and may last 4 to 12 hours.
  • The patient will be under general anesthesia throughout the surgery.
  • The incision on the belly is in the shape of an upside-down Y.


  • A nasogastric tube will be inserted through your nose into your stomach.
  • The nasogastric tube will drain secretions from your stomach, and it will remain in place for a few days until your bowel function returns to normal.
  • During the liver transplant operation, a tube will be placed through your mouth into your windpipe (trachea) to help you breathe during the operation and for the first day or two following the operation.


  • The tube is attached to a ventilator that will expand your lungs mechanically.
  • Small, plastic, bulb-shaped drains are placed near the incision to drain blood and fluid from around the liver. These are called Jackson-Pratt (JP) drains and may remain in place for several days until the drainage significantly decreases.
  • A tube called a T-tube may be placed in the patient's bile duct to allow it to drain outside the body into a small pouch called a bile bag.


  • The bile may vary from deep gold to dark green, and the amount produced is measured frequently. The tube remains in place for about 3 months after surgery.
  • Bile production early after the surgery is a good sign and is one of the indicators surgeons look for to determine if the liver transplant is being "accepted" by the patient's body.
POST OPERATIVE CARE


After surgery, the patient is taken to the intensive care unit, is monitored very closely with several machines. The patient will be on a respirator, a machine that breathes for the patient, and will have a tube in the trachea (the body's natural breathing tube) bringing oxygen to the lungs. Once the patient wakes up enough and can breathe alone, the tube and respirator are removed. The patient will have several blood tests, x-ray films, and ECGs during the hospital stay. Blood transfusions may be necessary. The patient leaves the intensive care unit once he or she is fully awake, able to breathe effectively, and has a normal temperature, blood pressure, and pulse, usually after about 3-4 days. The patient is then moved to a room with fewer monitoring devices for a few days longer before going home. The average hospital stay after surgery is 1-3 weeks.

A cardiac monitor or ECG machine is used so the doctor can see the heart rate and rhythm. There is a screen to show the wave form and number display. A cable from this machine which has 3 smaller cables is attached to0 your chest. There are also some beeps and buzzers that will go off from time to time.

Your blood pressure is also monitored and shown on the screen. As already mentioned you will not be able to eat or drink at first. To keep you more comfortable there will be another tube though your nose which empties your stomach. This tube is called a nasogastric tube. It is important because it can prevent nausea and vomiting. The nasogastric tube will be removed later in your recovery period. Your abdomen will be very sore post operatively because of the large incision made for the transplant. It is held together with the sutures or staples which are removed after healing has taken place.

In your immediate post operative period keeping track of fluid intake and output is critical. To accurately measure your urine output a foley catheter is necessary.

There will be some small tubes existing from the abdomen. Three small tubes called Jackson-Pratt drains or J.P’s are connected to suction bulbs to drain excess fluid from around the operative site where the new liver sits. As you recover and the excess fluid is removed the tubes will be removed. A small bag will also be present. It is called a bile bag and is connected to a T tube which sits in the common bile duct. Bile production is important and the collection of bile and its testing helps us determine liver function.

Diet: It is extremely important to follow the diet regimen as advised by the hospital dietician and the operating doctor during the hospital stay and after discharge of the patient. As liver transplant is a major surgery the food intake of the patient and monitoring of the same is very important as per the advice of the operating surgeon.

Medications: The immune system of the patients body doesn’t accept the donated liver as its own organ. It starts rejecting it. The operating surgeon will prescribe immuno suppressive medication and other medications for the patient recovery and acceptance of the donated liver. You must take these medications regularly as advised by the operating surgeon and till the time they are advised.

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