Peripheral Resections

Peripheral liver resections

Peripheral liver resections are surgical operations that include the removal of liver tissue at the peripheral (outside) parts of the liver. These surgeries are not widely commented as major hepatectomy and are commonly related to quicker recovery and reduced complication when properly chosen.

What Are Peripheral Liver Segments?

• The liver is subdivided into 8 parts

Peripheral resections will typically entail areas that are on the surface of the liver, including:

• Segment II and III (left lateral segments)
• Segment V & VI
• Segment VII (chosen superficial lesions)
• Segment VIII (only peripheral part)

Peripheral liver Resections types

• Wedge resection- Non-anatomical removal of small superficial liver tissue.
• Segmentectomy - Partial hepatic resection of one segment of the liver.
• Left lateral sectionectomy - Left segment II and III (common peripheral resection) resection.
• Restricted non-anatomical resections - Tumor-directed resection without adherence to segmental limits.

Indications

Frequent indications for peripheral liver resections include:

• Benign tumor 
• Primary hepatocellular carcinoma 
• Liver metastases 
• Selected cases Traumatic liver injuries.
• Diagnostic, or margin-clearance, procedures.

Benefits of Peripheral liver resections

• Maintenance of normal hepatic tissue.
• Lower surgical risk
• Applicable in patients with a small liver reserve.
• Rapid recovery of the operation.
• Repeatable with the occurrence of new lesions.

Peripheral hepatectomy surgery

Peripheral hepatectomy is a liver operation whereby diseased tissue at the outer (peripheral) parts of the liver is excised without the removal of as much of normal liver as possible. It is usually used in tumors of the liver which are superficial and it can be regarded as a small liver resection.

Preoperative Preparation

The patient is subjected to preoperative procedures before surgery:

• Extensive visualization (CT scan or MRI) in order to localize the lesion.
• Liver profiles and coagulation.
• Tumor markers in case of suspicion of cancer.
• Anaesthesia and physical examination.
• Preoperative starving of 6-8 hours.

Procedure

Anaesthesia and Positioning

• The procedure is done under general anaesthesia. 
• The patient is in the supine position (lying on his back). 

Surgical Access

• Laparoscopic (most common in the periphery lesions): miniature key-hole incisions.
• Open: when lesions are complex or multiple.

Liver Exploration

• Surface of liver is examined.
• Intraoperative ultrasound is done to ascertain tumor location and margins.

Vascular Control

• The blood flow to the specific location of the liver is monitored.
• In the event of a temporary inflow control, Pringle maneuver can be applied.

Liver parenchymal transection 

• Specialized devices are employed to cut the tissue in the liver. 
• Minute blood vessels and bile ducts are closed or ligated.

Resection of Hepatic Malignancy

• A portion of peripheral segment or wedge of liver is excised.
• Adequate tumor margins are provided in order to treat tumours.

Hemostasis and Bile Leak Inspection

• The bleeding points are subdued.
• A leakage of bile on the cut surface is checked.

Drain Placement and Closure

• One can put a drain close to the resection area.
• The closing of incisions is in layers.

Surgical time

• Laparoscopic: 1.5–3 hours.
• Open: 2 to 4 hours. 

Postoperative Care

• Recovery or ICU (typically 24 hours) monitoring.
• Premature mobilization and breathing.
• Gradual return to oral diet
• Should be drained out in a few days with no leak or bleeding.

Peripheral hepatectomy recovery

Peripheral hepatectomy recovery is generally faster and easier than major liver resection since a small part of the liver is resected. Result is dependent on if the surgery was laparoscopic or open, the condition of your liver and your general health. 

Recovery from surgery (first 24-48 hours) 

• Intensive observation in recovery room/ICU. 
• Managing pain using IV or oral drugs.
• IV fluids and antibiotics as necessary.
• Pulmonary exercises to avoid complications of lungs.
• Sitting and walking at an early age promoted.

Hospital Stay

• Laparoscopic: 3–5 days
• Open: 5–7 days
• Drain (when present) is normally removed when output is small.
• Slow transition of liquids to normal diet.

Pain and Wound Healing

• The pain is mild to moderate.
• The wounds of laparoscopy are healed at a very fast rate with less scarring.
• In open surgery incision care takes more time.
• Stitches or staples taken off between 7 and 10 days.

Liver Function Recovery

• The momentary increase in liver enzymes is typical.
• Normal liver functioning normally takes 2-4 weeks.
• Liver starts regenerating days after surgery.

Activity and Lifestyle

• Light exercises: in 1 week
• Walking encouraged daily
• Avoid 4-6 weeks of heavy lifting.

Return to work:

• Desk job: 2–3 weeks
• Intensive physical activity: 6-8 weeks.

Diet During Recovery

• Protein-balanced diet to aid in recovery.
• Adequate hydration
• Abstinence at least 6 -8 weeks.
• Frequent, small, meals in case of poor appetite.

Peripheral liver resection complications

Peripheral liver resection is mostly safe and comes with low complication rates than the major hepatectomy. Nevertheless, some risks and complications can be observed as with every surgery.

Early (Immediate) Complications

• Bleeding
• Bile Leak
• Infection
• Fluid Collection

Liver-Specific Complications

• Temporary Liver Dysfunction
• Post-Hepatectomy Liver Failure (Rare)

General Surgical Complications

• Pulmonary Complications
• Blood Clots
• Ileus

Late Complications

• Incisional Hernia
• Adhesions

Best hospital for peripheral liver resection India

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

Conclusion

Peripheral liver resection is a safe, efficient and liver-sparing surgical variant of treating selected tumors and benign conditions of the liver that are in the outer parts of the liver. It has a reduced level of stress in the operation, fewer complications and a quicker recovery rate, when compared to major hepatectomy but has the same good surgical outcomes. Due to the development of laparoscopic and robotic procedures, peripheral resections have provided less blood loss, shorter hospital admission and faster normalization of activities. Such complications as bleeding or bile leakage are rare and can be treated, particularly in case of operation at well-experienced centers. All in all, peripheral liver resection enables to save a maximum of healthy liver tissue, promotes a fast liver regeneration, and offers a good prognosis in the long run which is why it is a perfect solution in the case of the properly selected patients.

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FAQ

1. Is a liver resection of the peripheral liver major surgery?

• No. This is generally dubbed a "minor" liver operation, when 1 or 2 segments are resected.

2. Will my liver regrow after surgery?

• Yes. The liver is highly regenerative and restores volume within a matter of weeks following partial hepatectomy.

3. Can I still undergo peripheral liver resection if I have cancer?

• Yes. It provides good tumor clearance with favorable long-term outcome when used on appropriately selected patients.

4. Will I have to take long-term medication following surgery?

• There is nothing specific you need to take unless you have liver disease or cancer for which you are on treatment.

5. When do I call my doctor after discharge? 

• If you have fever, jaundice, worsening abdominal pain, vomiting or wound discharge.