Left Hepatectomy

Left hepatectomy surgery

Left hepatectomy refers to the resection of the left liver lobe (segments II, III and IV). It is primarily performed to treat liver tumors, bile duct disorders, trauma to the liver, or to treat a small number of benign liver diseases without impacting the remainder of the working liver. 

Left Hepatectomy Indications 

Left hepatectomy can be advised in case of:a

• Overwhelming liver tumors 
• Colorectal metastases to the liver
• Tumor of the bile duct of the left hepatic duct
• Noncancerous liver tumors 
• Straight in biliary or stones of the left hepatic system.
• Liver transplantation (left lobe donation)

Types of Left Hepatectomy

• Open left hepatectomy- It is performed by a larger cut on the abdomen. 
• Laparoscopic hepatectomy of the left side- Minimally invasive, small incisions are made. 
• Robotic left hepatectomy - Novice minimally invasive technique with increased accuracy.

Left hepatectomy procedure

Left hepatectomy refers to the resection of the left liver lobe (segments II, III and IV). 

Preparation before Surgery

• A full CT / MRI scan of the liver, to map blood vessels and bile ducts. 
• Liver functional tests and evaluation of future remnant of liver.
• Blood grouping and cross-matching.
• 6-8 hours preoperative fasting.
• General anaesthesia as arranged by the anaesthesiology.

Anaesthesia and Positioning

• General anaesthesia of patient.
• Supine position and slight reverse Trendelenburg.
• Abdominal region is cleaned and covered in sterile.

Surgical Approach

It is one of the following depending on the case:

• Open left hepatectomy- Right subcostal or midline incision.
• Laparoscopic left hepatectomy - 4-5 small incisions in the body's surface through which the surgeon operates with a camera and instruments. 
• Robotic left hepatectomy - Just like laparoscopy using robotic arms. 

Exploration of the Abdomen

• Surgeon examines liver and the abdominal cavity.
• Makes sure that it is resectable and without any surprise dissemination of the disease.

Left-Sided Liver Mobilisation

• Tearing of the left triangular and falciform ligaments.
• Seniority of the left lobe is emancipated.

Blood Supply and Bile Ducts Control

Ligation and identification of:

• Left hepatic artery
• Left portal vein
• Left hepatic duct

In case of necessity, temporary inflow control can be applied.

Liver Parenchymal transection

• The tissue of the liver is cut along the intended line.
• Special equipment (CUSA, harmonic scalpel, staplers) is utilized.
• Small vessels and bile ducts are thoroughly closed.

Left Liver Lobe Resection

• The left lobe (II, III, IV) is divided and displaced.
• Sample is forwarded to a histopath lab.

Hemostasis and Bile Leak Check

• Strict management of bleeding.
• Bile leakage test performed
• Surgical drain may be placed

Closure

• The layers of abdominal wall were closed one over another.
• Laparoscopic suture or staple incisions.

Duration of Procedure

• Depending on complexity and surgical procedure 3-5 hours.

Post-operative Care

• 24-hour ICU/high-dependency monitoring.
• Early mobilization and pain management.
• On oral the intake commenced slowly.
• Elimination of drain at a minimal output.

Left hepatectomy recovery

The healing period following the left hepatectomy is related to the methodology of the surgery (open vs laparoscopic/robotic), liver functionality of the patient and the disease. There is a clear stage-wise recovery guide given below.

Day 0-1 Immediate Post-operative Period

• ICU or high dependence unit monitoring.
• Epidural or IV epidural pain medication.
• Oxygen support if required
• IV fluids and antibiotics
• Breathing exercises early to avoid complications of the lungs.

Recovery Phase in the hospital (Days 2-7)

• Early ambulation (walking within 24 -48 hours)
• Slow change in liquids to soft and normal diet.
• Drainage output followed and most often eliminated in a few days.
• Liver functional blood tests regularly.

Discharge:

• Laparoscopic/robotic: 3–5 days
• Open surgery: 5–7 days

Home Recovery Phase (Weeks 2–4)

• Light fatigue and stomach pain are typical.
• Part-time work permitted.
• Never handle heavy objects (over 5kg). 
• Have a good balanced diet with plenty of protein. 
• Continue to do breathing exercises, and walks. 

Late Recovery Phase (Weeks 4–8)

• Slow resumption of normalcy.
• Driving normally allowed in 3-4 weeks.

Return to work:

• Desk job: 3–4 weeks
• Physical work: 6–8 weeks
• Complete wound healing in surgery.

Liver Regeneration

• The remaining liver starts to regenerate in 1-2 weeks.
• Vast functional improvement by 4-6 weeks.
• At least near-complete recovery in 2-3 months.

Pain and Scar Healing

• After 1-2 weeks, pain is decreased substantially.
• Laparoscopic/robotic surgery and smaller scars.
• Care of the scar recommended following the removal of stitches.

Diet During Recovery

• Low-protein foods (vegetables, skim milk, fibers)
• Plenty of fluids
• No alcohol during 3 months.
• Reduce fatty and fried food first.

Left hepatectomy risks

A major yet established liver surgery is left hepatectomy. It has good safety profile when conducted in well trained hepatobiliary centers. Nevertheless, being one of the major operations, there are some risks.

Common Risks (Early Complications)

• Bleeding
• Bile Leak
• Infection
• Pain and Fatigue

Liver-Specific Risks

• Temporary liver dysfunction
• Liver failure after hepatectomy

General Risks of Surgery

• Blood clots 
• Lung problems 
• Heart problems in high-risk patients
• Allergic reaction to anaesthesia

Late Complications

• Incisional hernia 
• Biliary stricture (bile duct narrowing)
• Adhesions leading to chronic tummy pain or bowel obstruction 

Best hospital for left hepatectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Left hepatectomy is a safe and long-standing major liver resection done to treat benign and malignant liver diseases. Under proper pre-operative assessment, highly qualified hepatobiliary surgeons, and advanced surgical procedures, the operation has low rate of complications and death particularly when compared with larger liver resections. This is because the liver has a great regenerative ability and the majority of patients are able to resume normal liver functioning after a few weeks, through which they are able to resume normalcy in their lives gradually. The least invasive interventions include laparoscopic or robotic left hepatectomy which improves the results even more due to decreased pain, blood loss, hospitalization and less recovery.

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FAQ

1. What portion of the liver is taken out in a left hepatectomy?

• The left lobe, comprising segments II, III and IV is resected.

2. Do you consider left hepatectomy a major surgery?

• Yes, it's a major surgery, but it's regarded as being less dangerous than a right hepatectomy because less liver is taken out.

3. Can the liver function be normal after left hepatectomy?

• Yes. The remnant liver will regenerate and compensate and most patients will have normal liver function.

4. Is laparoscopic left hepatectomy safe?

• Yes. It is safe, effective, and offers the potential for faster convalescence and less pain when performed at high-volume centers.

5. Is left hepatectomy feasible in patients with liver disease?

• Yes, but only after rigorous assessment. Patients with decompensated cirrhosis may not be suitable candidates.

6. Does age matter for left hepatectomy?

• Age is not a limiting factor by itself: overall health status and liver function are more significant indicators.