What is a liver resection?

A liver resection is an operation to remove part of the liver. When the right side of the liver is removed the gall bladder, which is attached to the liver, is also removed.

This operation is normally performed for cancer of the liver and requires major surgery which can take up to 10 hours.

How long will it take for me to recover?

You can expect to be in hospital for around 7 - 10 days and sometimes longer. It normally takes up to 3 months until you are back to your normal activities.

Will I have a wound?

Yes, you will have a fairly large wound across the upper part of your abdomen over your stomach area.

Will I become disabled in any way after the operation?

Although it takes some time for you to recover you should be able to return to your normal lifestyle after the operation.

Is it true that the liver regenerates after this operation?

Yes, your liver will regenerate in the period after your operation. Initially the rate of regrowth will be fairly fast with most of the liver tissue restored within the first few weeks after surgery.

Understanding your operation

Before you have your operation you will have the opportunity to discuss everything with your consultant. You will find it helpful to write down any questions that occur to you, even about simple things. If you can, bring your partner or a friend with you. They may help you to remember what has been discussed.

Please do not be afraid to ask any questions that you think of. It is very important that you understand the details of your surgery.

On the day of your procedure

We will ask you to come into hospital on the day before your surgery. This will allow us to make sure that all the necessary tests and investigations have been made. The following preparations will be made on the day of your surgery.

HDU bed:  After your operation you will be cared for in the High Dependency Unit and it is essential that there is a bed available for you before your operation starts. If no High Dependency bed is available on the day of your operation then your operation will be rescheduled for another day.

It can be very disappointing to prepare for a major operation and then sent home. We do understand this disappointment. We have no control over the availability of the beds. It helps if you are prepared for this possibility.

Fasting:  You will need to ‘fast’ in preparation for your surgery.  This means that you should not eat or drink within 6 hours of your operation. If you are diabetic, a special regime of glucose and insulin will be given through your drip and a close eye will be kept on your blood glucose level.

Premed:  Your anaesthetist may prescribe a sedative for you before you come down to theatre. This will help you relax and be prepared for your surgery.

During your operation you will be looked after by a team of anaesthetists, theatre nurses and surgeons and you will be closely monitored until you are fully awake.

Your surgeon will send samples of the tissue he removes to the laboratory for close examination. The results will be available for you in around 2 weeks.

It is very important in the first 24 hours after your operation that we are able to monitor your condition closely. For the first few hours after your operation you will be cared for in the High Dependency Unit within Ward 12, Level 5 of the Freeman Hospital.

There are a number of checks which are normal and are part of the routine care for anyone having your operation.  The Unit will regularly monitor the following.

Oxygen levels:  Following your anaesthetic you will require some extra oxygen. Oxygen helps you to recover well. This will be given through a face mask. On occasions this may be a little uncomfortable but it is important for you.

If you are finding it too difficult you may be given oxygen through nasal prongs which some people find more comfortable. Your oxygen levels will be monitored with a small probe that sits on your finger.

The physiotherapist will visit you regularly and help you with some breathing exercises, which will help keep your lungs clear, to maintain your oxygen levels.

Blood pressure, pulse and temperature:  Your blood pressure and pulse will be closely watched to check for any signs of complications after your operation. Your temperature will be monitored to check for any signs of infection. A sharp rise in your temperature may indicate that you have an infection. A slight increase in temperature is normal after surgery.

There will be a tube into a vein in your neck that will allow us to accurately monitor your fluid requirements and also to administer the fluids which you will require initially when you are not eating or drinking normally. This will prevent you becoming dehydrated. You may also have a drip in your arm.

Pain control:  It is very important that you are comfortable and pain free after your operation to allow you to breathe properly and to help you to move about as soon as possible. To achieve this, you will be given an epidural during your operation. This is a small tube into your spine through which strong painkillers can be given. After a few days, once you are drinking normally again, you can take regular tablets to help the pain and your epidural will be removed.

Blood sugar levels:  Your blood sugar levels will be watched closely after your operation. This is because one of the functions of the liver is to help control sugar levels within the body.

Nurses will regularly take a small amount of blood from your fingertip. Initially this will be performed every few hours but will happen less frequently after a few days.

Catheter:  When you pass urine it is a sign that your kidneys are working. To allow us to closely monitor this important function you will have a catheter placed in your bladder for a few days after your operation. This will be inserted after you are given your general anaesthetic and is therefore not painful or uncomfortable. After you are able to move around freely the catheter will be removed. This can be done in the ward and may be a little uncomfortable but not painful.

Wound drains:  A small tube will be inserted during your operation which will drain away any excess fluid from around the site of your surgery. The amount of fluid draining from this tube will be carefully monitored and the tube will be removed in the ward after a few days.

Blood samples:  In the first few days we will need to take blood samples from you at least once a day, if not more frequently. This is part of the careful monitoring process. As you recover from your surgery we will need to take blood less frequently.

Visitors:  It is natural for your friends and family to want to visit you after your surgery. However, we do recommend that only close family visit for the first few days after your operation. This is because initially you will tire very easily and need lots of rest. Once you are feeling better you can have more visitors.

Eating and drinking:  You can start drinking small amounts the day after your operation and eating within the next few days or so. Remember that your appetite may not be back to normal straight away but it helps if you can eat a little at normal mealtimes and also to drink plenty of fluid. This allows your drips to be removed.

Wound care:  You will have a fairly large wound in your upper abdomen, over your stomach, which will be closed by small metal clips. This will be checked every day to ensure that it is healing well. If your wound is clean and dry it will be left without a dressing on and you can bathe or shower as normal, taking care not to use any strong soaps or creams around the area. It may be that your wound leaks some darkish fluid or looks a little inflamed. This is not unusual and the nurses will observe it closely.

Let the nurses know if you notice any swelling or redness around your wound or if you start to feel ‘flu-like’. This may be a sign that you are developing a wound infection. This can normally be treated easily with antibiotics and careful monitoring.

Stitches:  Your stitches or staples will be taken out after 10 days. By then your wound should be fully healed. Even if the outer layer is not, the layers underneath the skin have been well secured at the time of operation and will be well healed.

Getting back to normal:  Within a few days of your operation you will be able to get up and around the ward for short periods and may be able to go home 7-10 days after your operation.  Being up and about early reduces the risk of the formation of blood clots (Deep Vein Thrombosis) and pressure sores.

After any major operation it takes some time to get back to feeling yourself again. Once all the tubes and drains have been removed you can still feel easily tired and emotionally upset. This is normal and as time passes you will begin to feel more like yourself again. Try to be patient with yourself and allow yourself some time to get over your operation.

The physiotherapist will visit you in the ward and make sure that you are managing to be mobile. She or he will give you some simple exercises which will help to strengthen you.

The dietician will also visit you to give you advice about your diet and will prescribe supplement drinks if you need them.

After you are home

Once you are home you can really start the process of getting back to normal. Initially your stomach area will feel heavy and you will still need to take regular painkillers.

You will tire very easily and need to keep ‘toddler hours’ - get up and go to bed early and take a short nap in the afternoon. If you are having difficulty sleeping, try to avoid caffeine or heavy meals in the early evening.

In a few weeks you will find yourself gradually getting back to normal.

Are there ever any complications?

Yes, as with all surgery there are sometimes problems which can arise either during surgery, or after your operation is finished. In the main these are problems which your consultant and his specialist team can deal with. Listed below are some of the complications that are most common after a liver resection. Please be aware that you are unlikely to develop all of the complications listed below and you may never develop any of them.

Bleeding:  Some bleeding is normal during the operation and is dealt with by the surgeon. You may be given a blood transfusion after the operation. If bleeding continues you might need to return to the operating theatre.

Bile Leaks:  Within the liver there is a complicated network of bile ducts. After surgery there can sometimes be some leakage of bile fluid into the surrounding area. You will be carefully monitored and may need surgery to resolve this if the leak does not heal itself.

Wound infection:  Some patients develop an infection in their wound. This slows down the rate at which the wound heals. Infections are treated promptly on the ward with antibiotics and dressings.

Liver failure:  On occasions the part of the liver that remains after surgery can stop working. This happens very rarely. Liver failure is the most serious complication that can develop and is one of the reasons that some patients do not survive their surgery.

Is there a chance that I could die from the operation?

Yes, there is a risk of dying associated with all operations, even when the surgery is considered to be minor.

Around 2 out of every 100 people who have a liver resection in the Freeman Hospital will die as a result of having the operation. This means that 98 of these patients do not die. You will be able to talk to your Consultant about the risks that apply to your surgery.

However, because a liver resection is generally performed after a diagnosis of cancer, the risk of not having the operation has to be balanced against the risks of the surgery itself.

Further information

If you would like any more information or to discuss this procedure in more details please don't hesitate to contact one of our Specialist Nurses for Hepato-pancreato-biliary (HPB) conditions:

Liesl Smith and Carol Gair

HPB Nurse Specialists

Telephone: (0191) 223 1452