LIVER SURGERY IN USA
Liver, the most
important purifying organ of body:
Liver surgery is performed for many indications. Most common of
them are liver trauma, removal of diseased part of liver, removing a cancer
from a particular part of liver or transplanting a liver from a donor.
Functions of liver:
Liver is very important organ of human body. It performs many
important functions which include production of some important proteins and
enzymes, purification of blood, production of bile and clearance of waste
products like bilirubin and ammonia. Some drugs use liver as their route of
excretion from body and their accumulation may result in case of hepatic function. Another
important function of liver is synthesis of some proteins which are helpful in
the process of blood clotting. These proteins are called coagulation factors
and most of them need vitamin K for their functioning giving them the name, vitamin
K dependent clotting factors. If liver function is impaired, these factors
cannot be synthesized leading to bleeding tendency in the sufferer. Bleeding can
occur from any part of body like mouth, nose, skin or urine.
LIVER ANATOMY
Anatomy of liver:
Liver is the largest gland of body weighing 1.5 kilograms. It is
located in the right upper quadrant of abdomen just beneath the muscular
diaphragm which separates it from chest. Liver is covered by thin layer of
membranous structure called peritoneum. Some part of liver is not covered by
peritoneum and is called bare area of liver. Liver has been divided
anatomically into two lobes, right and left. Right lobe is bulkier than the
left. There is further subdivision of lobes into segments. There are eight
segments of liver with each one supplied by its own arterial supply and venous
drainage.
There is an entry point on the under surface of liver which is
called porta hepatis or simply hepatic portal. It gives entry to portal vein
and hepatic artery and exit to biliary ducts and lymphatics draining the liver
parenchyma.
Liver is supplied by two systems of blood. One is through portal
vein which carries nutrient rich blood from the intestines to the liver, the
other is through hepatic artery. Venous drainage of liver is through hepatic
veins which ultimately drain in to inferior vena cava. Gallbladder is attached
to the under surface of liver in a specific place called fossa for gallbladder.
LIVER SEGMENTS
History of liver surgery:
Liver surgery has been carried out for quite some time with
variable results depending on the indication of surgery. There have been
advances in the surgical skills in liver surgery with improved outcomes
regarding injury to surrounding structures, infection control, blood loss
complications and blood born infection spread.
Indications of liver surgery:
Liver resection or hepatectomy can be performed for many
indications but is most commonly carried out to treat hepatic tumors. These tumors
can be indolent or aggressive. Indolent lesions are called benign tumors and
aggressive tumors are called carcinoma.
Most common benign tumors of liver are hepatic adenoma, hepatic
hemangioma and FNH or focal nodular hyperplasia. The most common aggressive tumor
of liver is the primary liver cancer also called hepatoma or hepatocellular
carcinoma. Other common cancer of liver is metastasis from a distant organ. for
example breast or colon cancer. Primary liver tumors are usually but not
necessarily single, whereas metastasis are usually multiple. Multifocal hepatic
cancers are also reported. Lymphoma is also common hepatic neoplasm.
Hepatocellular carcinoma is strongly associated with cirrhosis of
liver which in turn is associated with chronic hepatic infections like
hepatitis B and C. There is a long latent period before hepatic cancer develops
in such patients. Surgical treatment of hepatocellular cancer is usually not
very successful because of failure to diagnose at an early stage. This is the
reason why liver cancer screening is recommended for high risk population to
rule out cancer before it is too late.
Liver surgery has a variable success rate depending on many
factors like indication of surgery, surgical skill of surgeon, workload on the
surgeon and patients’ factors like diabetes or some other co-morbid chronic
diseases.
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