Hemihepatectomy Surgery: Procedure, Reasons, and Recovery

A hemihepatectomy is a surgical operation involving the removal of a substantial part of the liver. This complex procedure is performed by surgeons with specialized training for specific medical situations that require removing a large portion of this organ.

Reasons for a Hemihepatectomy

A primary reason for a hemihepatectomy is the presence of cancerous tumors confined to one side of the liver. This includes hepatocellular carcinoma, a cancer that originates in the main liver cells, and cholangiocarcinoma. When cancer has spread to the liver from another part of the body, removing the affected portion is part of the treatment plan. The goal is to remove the tumor entirely while leaving behind enough healthy liver to maintain function.

Benign, or non-cancerous, tumors may also necessitate a hemihepatectomy. Conditions like hepatic adenomas or large hemangiomas might require removal if they cause significant symptoms like pain or are at risk of rupturing. While these growths are not malignant, their size and location can interfere with the liver’s function, making surgical intervention appropriate.

Another application for this procedure is in living donor liver transplantation. In this scenario, a healthy individual donates a portion of their liver to a recipient in need of a transplant. The surgeon performs a hemihepatectomy on the donor to obtain the graft, which expands the organ pool for patients with end-stage liver disease.

Severe physical injury to the liver can also lead to a hemihepatectomy. Traumatic events like car accidents can cause extensive damage to the liver tissue and uncontrolled bleeding. In these emergencies, surgeons may remove the injured lobe to stop the hemorrhage and prevent life-threatening complications.

Understanding the Hemihepatectomy Procedure

The liver is divided into a right and a left lobe, which are further subdivided into eight functional segments. A right hemihepatectomy removes segments five through eight, which make up about 60% of the liver’s total volume. A left hemihepatectomy removes segments two through four, accounting for approximately 40% of the liver’s mass. The choice between a right or left procedure depends entirely on the location of the disease or injury.

Before the operation, patients undergo a thorough evaluation with imaging scans and blood tests to assess liver function and overall health. For cancer patients, chemotherapy might be used to shrink a tumor before surgery. The procedure is performed under general anesthesia.

Surgeons can perform the operation using two main approaches. The traditional method is open surgery, which involves a single long incision in the abdomen to directly access the liver. A modern alternative is minimally invasive surgery, done laparoscopically or with robotic assistance. This technique uses several small incisions and may result in less blood loss and shorter hospital stays.

The Recovery Journey

Following a hemihepatectomy, patients are closely monitored in an intensive care unit. The hospital stay can range from one to two weeks, depending on recovery progress. Pain is managed with medication, and drains are placed at the surgical site to remove excess fluid. Medical staff watch for immediate complications, such as bleeding, infection, or bile leaks.

Once discharged, the recovery process continues at home over several weeks to months. Fatigue and discomfort in the abdominal area are common during this period. Patients receive specific instructions regarding wound care to prevent infection at the incision sites. There will also be restrictions on physical activity, with a gradual return to normal routines as strength improves.

Dietary adjustments are often necessary during the initial recovery phase. A balanced diet is encouraged to support healing and liver regeneration. Following the surgeon’s and dietitian’s recommendations is an important part of the healing process. The body’s ability to process some substances might be temporarily altered, so following medical guidance on nutrition and medications is part of a successful recovery.

Liver Regeneration and Long-Term Outlook

The liver has a unique ability to regenerate after a portion of it has been surgically removed. The remaining healthy liver tissue begins to grow rapidly following the surgery, driven by the body’s need to restore normal liver function. Within a few months, the liver can regrow to its original size, proportional to the person’s body size.

Several factors can influence the speed and success of liver regeneration, including the health of the remaining liver tissue and the patient’s overall nutritional status. The long-term outlook after a hemihepatectomy is generally positive, with most individuals returning to a normal quality of life once they have fully recovered. Liver function typically returns to normal as the organ regenerates.

Long-term follow-up care is an important aspect of post-surgical management. This often includes regular appointments with the surgical team and may involve periodic imaging scans or blood tests to monitor liver function. The overall success of the surgery and the long-term prognosis are also closely tied to the reason the hemihepatectomy was performed. For cancer patients, continued surveillance is necessary to watch for any signs of recurrence.