Liver resection

Liver resection ( and partial resection of the liver ) is a surgical procedure in which a portion of the liver is removed. If one half of the liver removed, ie, the intervention hemihepatectomy.

The removal of the entire liver ( the hepatectomy ) comes - because the liver is a vital, indispensable organ - only in the context of transplantation surgery for the application.

Indication

Teilentfernug the liver may be necessary due to both benign and malignant diseases.

Some reasons for benign disease lead to the need for liver resection: These are located mainly in the liver ( intrahepatic ) abscesses, cysts or progressive local circulatory disorders of the liver.

Malignant diseases of the liver may, if they are locally exactly delineated, are sometimes treated with liver resection. More common are liver resections for the removal of solitary or localized ( segmental ) limited liver metastases.

Implementation

Basically, the access to the liver is similar to that for cholecystectomy: The patient is placed flat, a pillow or air role under the back stretch on the transition from the thoracic to the lumbar spine. About a cut along the costal edge or a Oberbauchquerschitt the liver is exposed.

Resection

Anatomical resection: In this case, an entire lobe of the liver or even individual, adjacent segments of their blood supply is removed accordingly. The segmental arteries, veins, and portal vein branches are this prevented close as possible to its origin from the parent vessels or closed with metal clips. This similarly applies to the bile ducts. Along the not always certain identifiable segment boundaries the soft parenchyma is then severed. Since all blood vessels and bile ducts are across interconnected via the segment boundaries, must be taken very carefully here on all blood and bile vessels, therefore ultrasound ( ultrasonic knife ) and high frequency surgical equipment newer generation are usually used. These can be used a "soft " achieve coagulation of the sensitive tissue without charring or carbonization, larger vessels can be easily identified and targeted closed.

Atypical resections or wedge resections be performed at close to the edge lying processes; An attempt is made to avoid a violation of the larger intrahepatic vessels as far as possible. This type of resection but does not adhere to predefined anatomical segments and may well exceed the segment boundaries.

Laparoscopic liver resection, rather than wedge resections performed as atypical anatomical segmental resections are performed in specialized centers since the early 90s. Late expansion of minimally invasive surgery of the liver surgery is due to the complex anatomy and partly severe intra-operative complications (eg bleeding gas embolism). Despite these hurdles, the laparoscopic interventions in increasing quantity and extent were successfully undertaken. This is confirmed in several studies, which could not detect any disadvantages of the laparoscopic approach over the conventional approach. In addition, some works have demonstrated advantages in the postoperative healing process.

For all processes, the control of bleeding and leakage of bile from the resection are the most important quality criterion. To avoid them come next to the modern coagulation technique above special, with coagulation -promoting substances ( Hemostats ) -impregnated collagen fleece fabric used.

Risks and possible complications

Bleeding during and after surgery ( intraoperative and postoperative) can not adequately supplied / unaidable larger blood vessels (the veins represent the bigger problem than the strong arteries here because of their delicate, zerreißlichen wall structure occur both diffuse from the resection as well as locally from accept and life-threatening proportions. broader When liver resections the need for blood transfusions is the rule rather than the exception.

Remaining pockets of residual blood ( hematoma) in the surgical field threaten to infect them with the consequences of an abscess or purulent peritonitis. At least as threatening to the so-called bilious peritonitis be by bile from the resection or an unsealed bile duct. These complications force almost regular way of the laparotomy ( Re- opening of the abdomen), or even a Etappenlavage, a regular abdominal opening with flushing and removal of pus and fibrin.

Less problematic is the emergence of a so-called Gallefistel that comes about when bile that comes out of the resection, but is derived over previously gelegete drains to the outside. Such fistulas are often made long to prepare without any real problems. Often they close without saying

Violations of the efferent biliary tree to Galleaufstau in the liver and thus to jaundice, lead to jaundice. Mostly, this situation makes intervention necessary. This may be followed by installation of a bile drainage to the outside again in operation, but also in ultrasound-guided puncture (PTC ) of the pent-up bile ducts.

Bacterial infections of the bile ducts can lead to chronic cholangitis with liver cirrhosis according to the following.

In the absence of severe complications the effect of liver resection is the function of the organ rather low. The high regenerative capacity of this organ resections allows up to four -fifths of the healthy liver tissue. The remaining residual organ can reach nearly output in quite a short time.

In order to minimize risks and possible complications in the future, there are different approaches. One approach is to take advantage of laparoscopy ( shorter hospital stay, less pain, less pain medication, cosmetically better result ) to be combined with the advantages of interactive imaging. However, the operation is to be placed in an open MRI ( oMRT ). The resulting images can show where the surgeon in real time the position and course of vulnerable structures such as arteries, veins and bile ducts, which he normally can not see. Goal is the certainty with which such structures are surgically to maximize and improve the orientation of the surgeon.

Rehabilitation and prognosis

After liver resection complications Bled no special rehabilitation measures are required. Otherwise they are to be set according to the type and intensity of complication (eg ARDS after long-term ventilation ). The prognosis depends on the underlying disease. If this is a benign ( liver abscess, etc.), the disease is of course brought to a standstill in the rule.

Colon cancer: If technically possible, liver metastasis of colon cancer should be removed.

The primary liver cell carcinoma, as long as it is operable, also treated by the resection. Prognosis and more treatment options in the main article.