Major and Minor Hepatectomy

A liver resection is a surgical procedure medically referred to as a hepatectomy to remove diseased or damaged portions of the liver. Because the liver has unique regenerative abilities, surgeons can remove a large portion of the liver, as the remaining healthy tissue can regenerate. The doctors primarily recommend this operation to treat liver tumours, which may have started in the liver or have spread. 

Understanding the difference between major and minor hepatectomies is especially crucial for patients with liver disease, as the extent of the procedure depends on the size, number, and location of the lesions. This section outlines clinical indicators that guide the administration of various treatments and surgical procedures, as well as the overall level of care provided by Gleneagles Hospitals, to achieve the high-quality patient outcomes.

The liver is the largest internal organ, with eight functioning units separated into right and left lobes. All segments have their own blood supply and bile drainage, which enables surgeons to remove certain parts of an organ without affecting the whole body. Accurate liver resections are based on this segmental architecture. 

The liver performs many vital functions, including digesting food with bile, purifying the blood, and storing vital nutrients. Since the liver is highly vascular, surgery must be highly accurate, and specialised tools are needed to regulate blood flow and ensure the safety of surrounding structures.

Minor hepatectomy refers to the removal of a small portion of the liver, often less than three segments. Surgeons usually perform it when the tumour is small and confined to a specific, easily accessible location. 

Segmentectomy: This is the resection of one segment of the functional liver.

Wedge Resection: This is the resection of a little non-anatomical triangle of tissue, typically used in the presence of lesions close to the surface. 

These processes preserve a high percentage of liver tissue, resulting in a shorter recovery period and a lower risk of postoperative liver dysfunction.

A major hepatectomy is a procedure in which three or more segments of the liver are removed. It is a more complicated task and is required for larger tumours or lesions located near major blood vessels. 

• Right Hepatectomy: The entire right lobe of the liver is removed.
• Left Hepatectomy: This involves the removal of the entire left side of the liver.
• Extended Hepatectomy: This involves the removal of a whole lobe with extra portions of the other side. 

Before performing a major resection, a surgical team must ensure that the portion of the liver that will remain after surgery is healthy and large enough to meet the body's demands.

At Gleneagles Hospitals, surgeons analyse every case to understand whether hepatectomy is the most appropriate treatment option. Surgery is conducted due to common reasons that include: 

1. Hepatocellular Carcinoma (HCC): It is the most prevalent form of primary liver cancer.
2. Metastatic Liver Disease: This is cancer that has spread to the liver from other parts of the body, such as the colon or rectum.
3. Benign Liver Tumours: Non-cancerous benign hepatic growths such as hemangiomas or adenomas that are painful and/or at risk of rupture.
4. Biliary Tract Cancers: Tumours that occur in the bile ducts in the liver.

A team of qualified hepatobiliary surgeons, anaesthesiologists and trained nursing staff is involved in the surgical procedure.

Pre-Surgical Preparation 

The surgical team carries out a detailed evaluation prior to booking the surgery. This includes: 

• Advanced Imaging: CT and PET may help evaluate liver anatomy, tumour location, and blood supply.
• Liver Function Tests: These are done in the blood to ensure the liver is functioning well after surgery.
• Medical Approval: Physicians will assess the patient's cardiac and pulmonary fitness to ensure that the patient is safe under anaesthetic care.

The surgery is performed in a special-purpose operating room with state-of-the-art equipment. Surgeons can use: 

• Intra-operative Ultrasound: This will help the doctors determine the exact positions of tumours and blood vessels during the operation.
• Minimally Invasive Surgery: When used, surgeons perform laparoscopic/robotic surgery, which is characterised by smaller incisions and a shorter recovery period.
• Open Surgery: In cases of very large tumours or complicated resections, a traditional incision may be required to achieve the safest outcome.

The crucial aspect of recovery after surgery is post-operative care. Patients are closely monitored to assess liver function and treat any temporary side effects. 

• Hospital Stay: Patients who have undergone minor hepatectomy can be discharged a few days after surgery, whereas major resections require longer hospital stays as part of follow-up.
• Pain Control: Healthcare professionals employ a range of interventions to ensure patients are comfortable throughout the recovery process.
• Liver Regeneration: The remaining liver tissue begins to grow rapidly, often reaching nearly normal size within a few weeks.

Although hepatectomy is a safe, well-established surgical procedure, it is a major surgery. Some of the possible complications include the following:

• Bleeding: The liver contains several blood vessels; therefore, surgeons are careful to control bleeding during and after surgery.
• Infection: It is very rare and treated using antibiotics straight away.
• Bile Leak: Sometimes bile can leak from the cut surface of the liver, which can be resolved with a small intervention. 

The medical staff at Gleneagles Hospitals has these risks under control thanks to constant monitoring and post-operative particular procedures.

The location and size of the liver lesions must be considered while determining whether to do a major and minor hepatectomy. Although a major resection is described as the removal of larger portions of the liver, the liver has an amazing ability to regenerate, thereby enabling a safe recovery in most cases. This means that an interdisciplinary approach at Gleneagles Hospitals guarantees each and every patient an accurate surgical procedure and comprehensive post-surgery treatment, with a specific focus on long-term liver health and a quick return to normal life.