Let's talk simply about Hepatectomy, a surgery that removes part of the liver.

It's normal to feel a little nauseous and scared when you hear the word "liver surgery." Because the liver is one of the most important and largest organs in our body. But for some diseases, especially serious conditions like cancer, removing the diseased part of the liver is the best solution to save your life. So today, let's talk about this 'hepatectomy', or the surgery to remove part of the liver, in a simple and clear way that will clear up all your doubts.

Why do you need to have this kind of surgery?

Okay, first let's see in what situations doctors decide to perform this surgery. There are two main reasons. One is as a treatment for a liver disease. The other is when a healthy person donates part of their liver to a sick person (Living Donor Liver Transplantation).

For liver diseases

This surgery is often done to remove tumors that have formed in the liver. These tumors can be cancerous, precancerous, or benign. There are two types of liver cancer.

1. Primary: This means the cancer starts in the liver.

2. Secondary: This means that cancer has started elsewhere in the body (for example, the colon) and has spread to the liver.

The main types of cancer treated with this surgery are:

• Hepatocellular carcinoma - This is the main type of cancer that begins in the liver.
• Cholangiocarcinoma - This is also a cancer that begins in the liver.
• Metastatic colorectal cancer - Spread of colon cancer to the liver.

This surgery is performed not only for cancer, but also for other medical conditions:

• Gallstones in the bile ducts inside the liver (intrahepatic ducts).
• Common tumors such as adenoma.
• Liver cysts.

A healthy person donates part of their liver

This is a great thing. When someone's liver is almost completely damaged and needs a liver transplant, a healthy person can donate part of their liver to that patient. In this type of donation, a part of the donor's liver is surgically removed. The amazing thing is that both the donor's remaining liver and the transplanted patient's new liver grow back into a complete liver.

How serious is this surgery? Are there any risks?

Yes, surgery to remove part of the liver is considered a technically complex and difficult operation . The main reason for this is that the liver has a large number of blood vessels spread throughout it. Therefore, excessive bleeding can occur during the operation. So, surgeons who perform this operation must have special training to avoid damaging blood vessels and control bleeding.

But there is this:

• Minor Resection: If less than half of the liver is removed, the risk is low. Such surgeries can now be performed using minimally invasive techniques such as laparoscopy or robotic surgery .
• Major Resection: If more than half of the liver needs to be removed, it is a bit more difficult and risky.

What happens before the surgery?

Before you undergo this surgery, the medical team will carefully consider several factors. Only then will they decide if this surgery is the right treatment for you.

Things doctors consider:

• Is your physical health strong enough to withstand such a major surgery?
• Can the tumor or diseased part of the liver be removed surgically?
• If it is cancer, has it spread to other parts of the body besides the liver?

Sometimes, if the cancerous tumor is large, it is possible to make surgery easier and safer by giving treatments such as radiation therapy or chemotherapy before surgery to shrink the tumor.

Also, doctors need to decide whether you need to have a partial liver transplant or a whole liver transplant. These factors will affect that decision:

• How far has the tumor spread?
• How healthy is the rest of your liver?
• Is the remaining liver part after surgery sufficient for the body's functions?

Preoperative tests

To know all this for sure, your doctor will order several tests, such as:

• Imaging tests: A CT scan or MRI scan.
• Liver function tests: These are routine blood tests.
• Liver biopsy: Taking a very small piece of the liver for examination.

What are the main methods of performing the surgery?

Hepatectomy surgery can be performed in three main ways. Your surgeon will determine the method that best suits your situation.

What happens to the part of the liver that is removed? Will it regrow?

Yes! This is the most amazing thing about the liver. The liver has an amazing ability to repair and regenerate itself.

Imagine, even if two-thirds of a healthy liver is removed, the remaining healthy part can divide again, grow, and regrow to its original size within a few weeks or months. Just like a lizard's tail regrows when it is broken off. But the speed of this regrowth depends on a number of factors.

• If you have previously received chemotherapy.
• If there is fat accumulation in the liver (fatty liver).
• If you have chronic liver disease such as cirrhosis.

In such situations, the rate of liver regeneration may be slightly slower.

What are the steps of the surgery?

Although there are slight variations depending on the surgical technique and the amount of tissue removed, the surgery generally goes like this:

1. Anesthesia: You will be put completely asleep (general anesthesia) before the surgery.

2. Making the incision: In open surgery, a long incision is made in the abdomen. In laparoscopy, several small incisions are made.

3. Preparing the liver: The surgeon will identify the exact part of the liver to be removed. An intra-operative ultrasound may be used during the surgery. If the part to be removed is close to the gallbladder, the gallbladder may also need to be removed.

4. Liver resection: The doctor carefully separates the liver tissue, identifies the blood vessels and bile ducts, and seals them with clips or staplers. Special instruments are used to control bleeding.

5. Removal of the segment: The separated liver segment is removed from the body. In the laparoscopic method, an additional incision of about 2-5 inches may be required to remove this segment.

Typically, this surgery can take between two and six hours .

What happens after the surgery? At the hospital

After the surgery, you will first be kept in a special unit (post-anesthesia unit) until you wake up from anesthesia, and then transferred to a regular ward. If the surgery was very complex, you may have to stay in the intensive care unit (ICU) for a day or two.

In the early days, you will have several tubes inserted into your body. These will drain fluids, provide relief to your stomach, and provide nutrition. The medical team will constantly monitor your blood pressure, sugar levels, and bleeding.

Once your condition stabilizes, you will likely stay in the hospital for a few more days or a week. During this time:

• Gradually, starting with liquid foods, they will begin to eat solid foods.
• He will get out of bed and start walking.
• The installed pipes will be removed gradually.
• You will be given the necessary medication to control the pain.

When I went home from the hospital, I was given a date to come see the doctor again in about two weeks.

Risks and Complications of Surgery

As with any major surgery, there are risks and complications that can occur, and it's important to be aware of them.

How long does it take to recover after going home?

It can take four to eight weeks to fully recover at home. You will need to take time off from work during this time.

• Avoid heavy lifting and strenuous exercise completely.
• It can take about 12 weeks to resume all normal daily activities.
• If laparoscopic or robotic surgery was performed, the recovery time may be a little faster.

To speed up the healing process, it is important to eat a protein-rich diet and do light exercise (like walking) . Try to walk for at least 30 minutes a day, but rest if you feel tired.

If you have these symptoms, see a doctor immediately.

If you experience any unusual symptoms after returning home, notify your doctor immediately.

• Fluid such as blood or pus oozing from the wound.
• Persistent fever.
• Vomiting or diarrhea.
• Constipation lasting more than three days.
• Abdominal swelling.
• Yellowing of the eyes and skin (Jaundice).

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