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04 February 2021

İsmail Sert

General Surgery Specialist

Liver Surgery

Liver Surgery

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  • What is the liver surgery?
  • The liver is the largest internal organ in the human body. The liver, located in the upper part of the abdomen, contains a lot of blood due to its dense vascular structure. The blood after being circulated from the spleen and digestive system, is filtered in the liver in order to reach the heart. As a result of this situation, the risk of bleeding is high, liver surgery is very difficult and risky. Liver surgeries must be performed by experienced and specialist physicians. Liver surgery is applied in the treatment of the following diseases.

 

  • What is liver hemangioma?
  • It is the most common benign liver tumor that is usually seen in women between the ages of 30-70. They are encapsulated tumors that expand and grow like varicose veins and contain vascular structures. 40% of patients have more than one. They can be found equally all over the liver. Usually less than 5 cm in diameter. Those larger than 5 cm in diameter are called giant hemangiomas. It mostly constant in size as it was while the diagnosis. Rapid growth can be seen in rare cases.

 

  • What are the symptoms?
  • Giant hemangiomas can cause complaints such as early satiety and jaundice by pressing on the organs around them. In addition, it may cause abdominal pain due to the tension created in the liver membrane. In some rare cases, hemangiomas located close to the liver edges may rupture spontaneously due to trauma.

 

  • How is it diagnosed?
  • Liver hemangiomas are often seen incidentally during surgery or imaging methods such as ultrasonography and computed tomography.

 

  • How is it treated?
  • In cases where there is no suspicion of cancer, if there is no complaint in the patient, hemangiomas can be followed at long intervals. Those with symptomatic and compression findings and those who grow rapidly should be operated on. In addition, surgical treatment should be applied to individuals at risk of trauma, such as athletes. It is possible to remove them so that the liver tissue is preserved. Although rare, liver transplantation may be required in giant hemangiomas that cannot be surgically removed.

 

  • What is liver adenoma?
  • One of the most important risk factors for liver adenoma, which is more common in women, is the use of birth control pills. Adenomas are neatly circumscribed, soft tumors with areas of necrosis and bleeding on the cross-section.

 

  • What are the symptoms?
  • Approximately 50% of patients complain about abdominal pain. In about 30%, spontaneous disintegration and related life-threatening intra-abdominal bleeding may occur.

 

  • How is it diagnosed?
  • Patients may present with a mass in the liver or the mass can be seen incidentally on ultrasonography or computed tomography. Biopsy cannot be performed due to the risk of bleeding.

 

  • How is it treated?
  • Adenoma may shrink by avoiding birth control pills . However, it must be surgically removed as there is a risk of turning into cancer and can lead to life-threatening bleeding.

 

  • What is focal nodular hyperplasia (FHN)?
  • It is the second most common benign liver tumor. It consists of sheathed pale nodules and are usually smaller than 5 cm. It is mostly seen in women aged 20-30.

 

  • How is it diagnosed?
  • Since it usually does not cause any symptoms, it is diagnosed incidentally. It causes mild abdominal pain in about 10% of patients. 

 

  • How is it treated?
  • If there is no increase in the diameter of FNH in regular follow-ups and it is less than 5 cm, it does not need to be operated. Whereas lesions with a suspicion of malignant tumors, with signs of compression around and tend to grow should be surgically removed. 

 

  • What is liver cyst hydatic?
  • The causative agent of hydatid cyst is a parasite named E. Granulosus. This parasite usually settles in the liver at the right lobe site of the liver. It is more common in areas where animal husbandry is concentrated. Those who feed pets without providing suitable conditions, those who deal with animal husbandry and do not provide the necessary hygienic conditions, and those who consume foods that are not produced under hygienic conditions although they do not have a relationship with animals are at risk in terms of cyst hydatid development.

 

  • What are the symptoms?
  • Over time, the agent forms a fluid-filled cyst in the liver. From the cyst of this fluid, there are 'girl cysts' that can form new cysts wherever it reaches if the cyst bursts. Cysts can open into the abdomen, bile ducts, and chest cavity. Simple cysts are usually asymptomatic. When it is symptomatic, the most common complaint is abdominal pain. When the cyst is infected, and when it opens into the abdomen, chest cavity, bile ducts or compresses other organs, it can cause abdominal pain, in addition to abdominal pain, fever, jaundice, chills and even life-threatening situations known as shock.

 

  • How is it diagnosed?
  • The diagnosis of liver hydatid cyst is made with the help of ultrasonography, CT, x-ray and MRI and some immunological tests.

 

  • How is it treated?
  • First of all, drug therapy is applied. However, since response to drug treatment is generally not obtained, surgical treatment is essential. The surgical method to be chosen depends on the condition of the patient and the stage of the cyst. In recent years, some patients, especially the early diagnosed ones, have been treated by draining the cyst by inserting a needle through the skin and injecting alcohol into it, accompanied by imaging methods, and successful results have been achieved.
  • Hydatid cyst caused by E. Multilocularis is much more severe. The cyst has no capsule. It tends to grow steadily and progress to surrounding organs. In this case, the inside of the liver is filled with small and large cysts. It grows like a malignant cancer and progresses to the surrounding organs and bile ducts. The most important factor in the success of the treatment is that the patient is operated before the disease progresses to organs other than the liver and bile ducts. Surgical treatment is extremely difficult. Resection (surgical removal procedure) should be performed in patients with early diagnosis. Liver transplantation can be applied to patients who cannot be resected.

 

  • What is liver absence?
  • It is usually seen in patients with any foci of infection in the abdomen (eg delayed appendicitis), inflammation of the gallbladder or main bile duct, and parasite cysts in the liver (hydatid cyst).

 

  • What are the symptoms?
  • It manifests itself with abdominal pain (in the upper right side of the abdomen), high fever (39-40 C °), chills and sweating, sometimes jaundice, loss of appetite, sepsis in delayed patients (signs of advanced infection), and a related shock image.

 

  • How is it diagnosed?
  • It can be diagnosed by imaging techniques such as ultrasonography, CT and MRI.

 

  • How is it treated?
  • Antibiotic treatment should be started immediately after diagnosis. Antibiotherapy alone may be sufficient in patients with amoeba abscess. Nowadays, evacuation of the abscess by placing a non-surgical catheter under ultrasonography is preferred as the first step of treatment. In cases where this treatment is not sufficient, the abscess should be surgically drained as soon as possible.

 

 

Assoc. Prof. Dr. İsmail SERT

General Surgery