The liver (hepar) is the largest gland in the human body. A defect and liver disease can very quickly become dangerous. In particularly serious cases, the only remaining option is liver surgery.
Here you will find further information as well as selected specialists and centers for liver surgery.
The liver is a large and most important metabolic organ located in the right upper abdomen. The liver is divided into two larger parts, the right and left liver lobes, and these in turn are divided into a total of eight segments. The right lobe of the liver is significantly larger than the left.
The liver receives the blood of all unpaired abdominal organs with the nutrients it contains from the intestine via the portal vein, which is a vessel the size of a thumb.
The main functions of the liver are, for example
Thanks to this wide range of functions, the liver is also regarded as the central hub of the human metabolism. Diseases of the liver and restrictions in its function can therefore quickly become life-threatening, which is why early detection and treatment are extremely important.
This video contains further illustrative information on the anatomy of the liver and its functions:
Below you will find an overview of the different types and purposes of liver surgery:
A biopsy is the removal of a tissue sample for subsequent examination in the laboratory.
A liver biopsy is the most suitable method for diagnosing diffuse or unclear liver diseases such as viral hepatitis. The procedure is no longer carried out blindly, but is supported by imaging techniques.
A biopsy needle is used to remove a tissue cylinder from the liver for further histological examination.
The procedure is carried out under local anesthesia at the puncture site and can be performed on an outpatient basis. However, bed rest is recommended on the day of the procedure due to the possible risk of bleeding.
During an ascites puncture (ascites = abdominal fluid), a long needle is inserted into the abdominal cavity and abdominal fluid is removed. This is done under local anesthesia and using ultrasound.
The abdominal fluid - a maximum of five liters - drains out of the abdominal cavity through the puncture needle under sterile conditions. At the end of the treatment, the hollow needle is withdrawn and the puncture site is sutured.
In principle, the plastic tube can initially be left in place as a drainage tube so that the fluid can drain away. However, it is important that the puncture site is bandaged with sterile material. Otherwise, there is a risk of peritonitis with serious (even fatal) complications.
During a liver transplant (medically known as a liver transplant), the diseased liver is removed and replaced with a donor liver within 16-24 hours. This is a major and very demanding liver operation that must be thoroughly planned. It is only indicated if the function of the liver is so severely restricted that the patient's life is at risk.
The incision is usually made along the costal arch or inside the right upper abdomen. The muscles of the abdominal cavity are then spread and the abdominal cavity is opened. The diseased liver is then removed (medical term: hepatectomy) and the donor organ is inserted. It is important that the donor organ is connected to the blood vessels (artery and vein) of the donor.
Careful blood positioning and the insertion of drains are essential in order to drain wound secretions and blood for the first few days after the operation. Post-operative bleeding or infections can thus be detected and treated at an early stage. The abdominal wound is then closed again and covered with sterile plasters.
The anatomy of the liver © Henrie @ AdobeStock
Liver cysts are fluid-filled spherical formations in the liver that are usually benign. They can occur spontaneously or as a result of infections (usually caused by parasites such as worms). Cysts that occur spontaneously can usually be left as they are, but should be observed.
If the cyst is or becomes so large that liver function is impaired, the cyst should be opened or removed. Sometimes the cysts also cause increasing pain, which is difficult to treat. The risk of the cyst bursting increases with the diameter of the cyst, so that ultimately the size can also be a reason for cyst removal.
The operation can be performed by laparoscopy. In some cases, if the cyst is superficial, the cyst is opened without a skin incision, simply by a puncture through the skin (percutaneous). However, it is extremely important that no cyst contents enter the abdominal cavity. This could otherwise lead to the spread of parasites.
Open surgical treatment is recommended for larger findings or deep cysts. This is carried out through an incision in the right upper abdomen under the costal arch or in the midline. The affected liver lobe or segment is then exposed and the cyst is loosened and punctured so that the contents can be aspirated. The cyst can then be safely excised.
The liver has amazingly good self-healing powers. It is possible to remove up to 75% of its mass and it can then regenerate itself again. This type of partial liver removal is known as a segmental resection or hemihepatectomy. Hemihepatectomy means that one lobe of the liver is removed, hemi comes from half.
However, if the entire organ has to be replaced (= hepatectomy, liver resection), a donor organ, i.e. a liver transplant, is required. As liver resection is generally a major operation, laparoscopy is only possible in rare cases. In most cases, the abdominal cavity must be opened through a long incision in the right upper abdomen or midline in order to gain extensive access to the organ.
The liver is heavily supplied with blood. During a large segment resection, the patient therefore loses a lot of blood when the diseased part of the liver is removed. In the event of heavy bleeding, the portal vein is therefore temporarily clamped. This greatly reduces the blood supply to the liver (known as the Pringle maneuver).
However, due to the lack of blood supply, the remaining liver, which is supposed to be preserved, is exposed to a lack of oxygen. This deficiency damages the remaining liver (hypoxemia), increases the risk of complications and can lead to liver failure.
Other measures to reduce the tendency to bleed include the gentle separation of tissue layers using a water jet (water jet dissection). This means that tissue is not cut open but forced apart. This device is now available in many clinics.
An unnoticed injury to small bile ducts can lead to a so-called "biliary fistula", in which bile leaks into the abdominal cavity. In such cases, a second operation is usually unavoidable.
A transjugular intrahepatic portosystemic shunt (TIPS) is a bypass circuit for the liver flow area. As a result, part of the portal vein blood no longer flows through the liver, but directly into the inferior vena cava. This treatment option is used, for example, for bleeding in the oesophagus due to excessive pressure in the portal vein area or in preparation for a liver transplant.
Under general anesthesia, the jugular vein in the neck (internal jugular vein) is first punctured. An angiography catheter is then advanced via the right atrium, the superior and inferior vena cava into the hepatic vein and finally the portal vein. A balloon catheter and stent are then used to create a connection between the portal vein and the hepatic vein, permanently connecting them (= shunt; "short circuit of two vessels"). The majority of the blood then flows through this shunt and relieves the liver.
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