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Wednesday, November 5, 2008

Other Liver Related Surgeries


Liver surgery comprises various operations of the liver for different disorders. The most common operation performed on the liver is a resection (removal of a portion of the liver). The most typical indication for liver resection is a malignant tumor. Tumors can be primary (developed in the liver) or metastatic (developed in another organ, then migrated to the liver).

In liver surgery, tumor resection is often the only curative treatment for patients suffering from liver cancer. A liver resection takes approximately 3-5 hours and can be performed without the need for blood transfusion (see bloodless surgery). Up to 75% of the liver tissue can be safely removed. The hospital stay is about 5 days and complete recovery occurs in 5-6 weeks. The resected liver regenerates to its preoperative size in 6-8 weeks. Excellent results from liver resections are usually achieved.

Hepatobiliary Surgery

The following is a list of the most common hepatobiliary conditions and procedures.
Common Conditions
Primary Liver Tumor
  • Hepatocellular carcinoma
  • Hepatoblastoma
  • Cystadenocarcinoma
Metastatic Liver Tumors
  • Colorectal cancer
  • Pancreatic cancer
  • Carcinoid tumor
  • Neuroendocrine tumor
  • Adrenal carcinoma
  • Soft tissue tumors/sarcoma
  • Gastric cancer
  • Breast cancer
  • Melanoma
  • Ovarian cancer
Benign Liver Tumors
  • Adenoma
  • Cavernous hemangioma
  • Focal nodular hyperplasia
Liver Cyst / Abscess
  • Polycystic liver disease
  • Congenital cyst
  • Liver abscess
  • Hydatid cyst
Gall Bladder Tumors
  • Gall bladder cancer
  • Gall bladder polyp
  • Porcelain gall bladder
  • Cholangiocarcinoma
  • Klatskin Tumor
  • Choledochal Cyst
  • Post-Cholecystectomy Stricture
Common Procedures
Minimally Invasive Liver Procedures
  • Diagnostic laparoscopy and biopsy
  • Radiofrequency ablation (RFA)
  • Percutaneous ethanol injection
  • Hepatic artery infusion pump
  • Hepatic artery chemoembolization
Conventional Liver Procedures
  • Hepatectomy
  • Marsupialization or unroofing of liver cysts
  • Drainage of liver abscess
Gallbladder and Biliary Procedures
  • Radical cholecystectomy
  • Resection of Klatskin tumors and cholangiocarcinoma
  • Bile duct reconstruction
  • Common bile duct exploration
Surgery for Portal Hypertension

Radiofrequency ablation, sometimes referred to as RFA, is a minimally invasive treatment for cancer. It is an image-guided technique that heats and destroys cancer cells. Radiofrequency ablation is used to treat two types of liver cancers 1) Hepatocellular carcinoma, which is a primary liver cancer (meaning it begins in the liver) and 2) Colon cancer that metastasizes or spreads from the colon to the liver.

A special needle electrode is placed in the tumour under the guidance of an imaging method such as ultrasound, computed tomography (CT) scanning, or magnetic resonance (MR) imaging. A radiofrequency current then is passed through the electrode to heat the tumour tissue near the needle tip and ablate—or eliminate—it. The heat from radiofrequency energy also closes up small blood vessels, thereby minimizing the risk of bleeding. In general, radiofrequency ablation causes only minimal discomfort and may be done as an outpatient procedure without general anaesthesia.

Portal hypertension is increased blood pressure in the veins of abdominal organs. The primary vein that carries blood from the abdominal organs to the liver is called the portal vein. When this vein clots or when the liver develops scar tissue from disease and compresses the vein, the blood pressure in the vein goes up and portal hypertension develops. Portal hypertension surgery is indicated in patients who have severe hemorrhaging, or internal bleeding, due to varices that cannot be controlled.

The surgical procedure that is most commonly used is called distal splenorenal shunt (DSRS). The DSRS is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and attached to the left kidney (renal) vein. This surgery selectively reduces the pressure in the varices and controls the bleeding. In DSRS, a patient receives general anesthesia. A surgeon makes an incision in the abdomen to access the blood vessels around the liver and joins the splenic and left renal vein. This action reduces blood pressure in any esophageal varices.The procedure has a 90 percent success rates at preventing bleeding from recurring.

Gallbladder surgery – also known as cholecystectomy – is used to treat gallstones, cancer and other disorders that affect the gallbladder. The gallbladder is the organ that stores excess bile not immediately needed for digestion.

This surgery can be performed as either laparoscopy or traditional open surgery. A gallbladder operation is usually done using "keyhole" surgery - also known as laparoscopic cholecystectomy. This means your surgeon can remove the organ without having to make a large cut on your abdomen. During laparoscopy, several small incisions are made in the abdomen and a thin, tube-like instrument called a laparoscope is inserted into the body. A camera and light attached to the laparoscope provide images of the gallbladder that are transmitted to a monitor, allowing the surgeon to view the abdominal cavity while removing the gallbladder. This technique is used in the vast majority of gallbladder surgeries because it is less invasive and reduces scarring and the potential for post-surgical pain and complications.

Hepatobiliary surgery consists of highly technical challenging procedures that deal with all pathological conditions that affect the liver, gallbladder, bile ducts, pancreas, and duodenum. These conditions can be the result of congenital abnormalities, inflammation, infection, benign or malignant tumors, or the result of traumatic injuries. Hepatobiliary Surgery is a natural extension of liver transplantation.

Pancreatic surgery encompasses a wide variety of surgical procedures concerning the pancreas (a gland located behind the stomach just below the liver). Disorders of pancreas can be divided onto those caused by tumors (benign or malignant) and those caused by inflammation (acute or chronic). Distal Pancreatectomy involves removal of the tail of the pancreas, or the tail plus a portion of the body. The spleen is sometimes removed as well. Total Pancreatectomy

Operations on the pancreas typically require an abdominal incision with some dissection of the stomach and intestines to expose the pancreas located deep within the abdomen. Many of these endocrine tumors may be dissected out of the substance of the pancreas, but in some cases may require partial removal of the pancreas (pancreatectomy).
removes the entire pancreas, and is rarely used.

ERCP stands for endoscopic retrograde cholangiopancreatography. It is a procedure that uses an endoscope to examine and x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla and gallbladder. An endoscope is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. The purpose of the examination is to detect any diseases or irregularities in the bile or pancreatic ducts. The examination may be used to locate, and in some cases remove, gallstones stuck in the bile duct. It is also possible to reveal cancer, infections and cirrhosis of the liver.To investigate jaundice where the patient goes yellow as the result of a blockage to the bile ducts and to investigate otherwise unexplained abdominal pain.

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