Liver Resection

WHAT YOU SHOULD KNOW:

• Liver resection is surgery to remove an area of your liver. Your liver is an organ that lies in the upper right side of your abdomen (stomach). Your liver has many functions including removing waste products from your blood. It breaks down your blood so your body can better use the nutrients. Your liver also helps control your blood clotting. The liver has a right and a left lobe, and can be divided into eight segments. The liver is the only organ in your body that can renew itself.
  
  
• The most common reason for a liver resection is to remove liver cancer or liver metastases. Metastases are cancer cells that have spread to your liver from another area of your body. Liver resection also may be done for noncancerous liver problems. Some people choose to donate a part of their healthy liver to someone who needs a liver transplant. Ask your caregiver for more information about live liver donation.
  
  
• Before having a liver resection, imaging tests are done to help plan your surgery. You also will need tests to check the function of your liver. The amount of your liver that will be removed depends on where the diseased areas are found. Because the liver can renew itself, over half of your liver can be removed if needed. During surgery, your caregiver will check for other diseased areas not found before surgery. Having a liver resection may decrease symptoms of liver problems such as abdominal pain and yellowing skin. If you have cancer, it may prevent it from spreading. A liver resection may even cure your cancer.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic response to the medicines used during, and after your surgery. The fluids used during your surgery may build up in your abdomen and lungs. Extra fluid may make it hard for you to breathe. If you have cancer, when your tumor is removed cancer cells may spill out and form a new tumor. Even if your cancer is removed, it may come back, and you may need another liver resection. During surgery, your blood vessels may be damaged, and you may lose large amounts of blood. Air may also enter your blood vessels which could be life-threatening if it enters your heart.
  
  
• After surgery, bile may leak from your bile ducts into your abdomen. You may get a wound, abdominal, or lung infection. You may also have an abscess (pus pocket) form in your abdomen. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening. Your lungs and heart may not function as they should, and you may have a heart attack. The remaining area of your liver may fail, and you may die.
  
  
• Without surgery, your symptoms, such as jaundice and poor nutrition, may worsen. If you have cancer in your liver, the cancer may spread to other areas of your body. Your liver function may worsen causing your liver to fail, and you may die. Ask your caregiver if you have questions or concerns about your condition, surgery, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV is a tube that is placed in your vein for giving liquids and medicines.
  
  
• Antibiotics: You may be given antibiotics before, and after your surgery. Antibiotics help prevent infection from bacteria called germs.
  
  
• Pre-op care: You may be given medicine that makes you relaxed and sleepy right before your surgery. You also may be given medicine to dilate (widen) your blood vessels. These medicines can decrease the pressure in your blood vessels to help decrease blood loss during surgery. You will be taken on a stretcher to the room where your surgery will be done. You will need to lie on your back on the surgery table.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may have a tube placed in your mouth and throat. This tube is called an endotracheal (ET) tube. Usually, you are asleep before your caregiver puts the tube into your throat. You will be completely asleep and free from pain during surgery.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Rectal temperature: A special thermometer may be put into your rectum so caregivers can monitor your temperature during surgery. Your rectum is the end of your bowel.
    
    
  • Arterial line: This is a tube placed into an artery (blood vessel), usually in your wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line measures your blood pressure and may be used for taking blood.
    
    
  • Central venous pressure line: A central venous pressure (CVP) line is a thin tube put in a vein near your collarbone, or in your neck or groin. The CVP line can monitor the fluid and pressure in your blood vessels. The CVP line also may be used to give medicines or IV fluids.
  
  
• Foley catheter: A foley catheter is a tube that is put into your bladder to drain your urine into a bag.
  
  
• Nasogastric tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty.
  
  
• Blood transfusion: You may need a transfusion during surgery if you lose a large amount of blood. During a blood transfusion, you will get whole blood, or parts of blood through an IV. You also may need a blood transfusion after your surgery.

During your surgery:

• Your caregiver will make an incision (cut) in your abdomen just below your ribs. Muscles and other tissues will be moved aside to help see your liver better. An ultrasound may be done during surgery to look for unknown areas of disease. If the right side of your liver is being removed, your gallbladder also will be taken out. Lymph nodes will be removed if they look diseased, and sent to a lab for tests. Lymph nodes are small tissue lumps that help your body fight illness and disease. Clamps may be used to stop the blood flow through your liver during surgery. The clamps may be removed for short times during surgery to allow some blood to flow through your liver. The blood vessels attached to the area to be removed will be cut and closed to stop any bleeding.
  
  
• Your caregiver will remove one or more segments of your diseased liver. Sometimes, only a wedge (portion) of a liver segment needs to be removed. The clamps will be removed so blood can flow through the remaining part of your liver. Your caregiver may use stitches, special glue, or a laser beam to stop any areas of bleeding. Your cut will be closed with stitches, or tissue glue and covered with a bandage. The liver tissue that was removed may be sent to a lab for tests.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Do not get out of bed until your caregiver says it is okay. A caregiver may remove your bandages soon after your surgery to check your wound (surgery site). When caregivers see that you are not having any problems, you will be taken to your hospital room.

• Medicines: You may be given the following medicines:
  
  
  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.
  
  
• Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Preventing deep vein thrombosis: Deep vein thrombosis (DVT) is a condition where blood clots form inside your blood vessels. This can easily happen after having surgery. Ask your caregiver for more information about deep vein thrombosis. The following can help prevent clots from forming inside your veins:
  
  
  • Compression stockings: Your caregiver may have you wear compression stockings. These are tight elastic stockings that put pressure on your legs after your surgery. The pressure is highest in the toe area and decreases as it goes toward your thighs. Wearing pressure stockings helps push blood back up to your heart and keeps clots from forming.
    
    
  • Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.