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Liver Surgery

Why do I need a liver resection?

Liver resection is offered to patients who have or are thought to have a tumour (growth) on the liver. A tumour is an abnormal growth of cells and may be described as malignant (cancerous) or benign (non–cancerous). You may also be offered a liver resection if you have already had a bowel operation for bowel cancer and been found to have liver metastases (secondary cancer cells in the liver). The diagram below will be used to show you where
your tumour/s is. The liver is divided into eight segments and the detailed knowledge of the liver allows your Surgeons to plan your operation.
The surgeon will discuss with you the exact operation in more detail. You will have already undergone many tests and investigations. The results of these tests have been looked at carefully by a team of specialists known as the Multi-Disciplinary Team (MDT). This team includes Consultant Surgeons, Consultant Physicians, Consultant Radiologists (experts in taking and reading X-rays and scans) and Clinical Nurse specialists. The team has been able to make a diagnosis of your condition/illness, and a decision made about how best to treat it. As a result, they have suggested that
you have a liver resection. This will have been discussed with you. Only a relatively small number of patients with liver tumours are suitable for surgery, and whether or not this operation is an option for you depends on:

• Whether the tumour in your bowel has been treated/
is treatable.
• How much of the liver is affected.
• The size of the tumour(s).
• Where in the liver the tumours are located.
• Whether there are any tumours outside the liver.
• Your general level of fitness.

Dr Sandroussi - liver resection

What is a Liver Resection

Liver resection is an operation to remove a part of the liver. If the right side of the liver is removed, this is known as Right Hemihepatectomy. The gallbladder is also removed at the same time. If the left side of the liver is removed this is known as a Left Hemihepatectomy.

The liver has the ability to repair and regenerate (grow back) itself. Up to 65% of the liver can be removed. The remaining liver will regenerate itself following surgery and will grow back to its original size in about 3 months. Most liver resections are performed during (open) surgery through
an incision (cut) in your abdomen. However, sometimes they may be done through (keyhole) surgery. This may not be suitable for some patients for a number of reasons including the size and/or the number of tumours to be removed as this makes the operation more complex.
Are there other types of treatment I could have? There are other treatments possible for liver tumours, which include ‘burning’ the tumour (ablation). This treatment is usually indicated in combination with liver surgery if there are many tumours to treat. It is also reserved for patients that cannot undergo a general anaesthetic. Radio-frequency ablation and microwave ablation are the two-ablation techniques that are commonly used.
Nearly all patients have chemotherapy after surgery. Some patients undergo chemotherapy before surgery. ‘Neo’-adjuvant or pre-operative chemotherapy is advised in certain situations where the tumours in the liver are too large to be removed. They require chemotherapy first to try and ‘shrink’ the tumours.

Are there any risks in having the operation?

As with all operations, the surgery and the anaesthetic carry risks to your health. Some of the risks of this operation can be serious. However, you will be under the care of a specialist team of Doctors and Nurses, who will monitor your condition to make sure that any complications that occur are treated as soon as possible. Liver resection is a major operation and is done under general anaesthetic. This means that you will be unconscious and unaware
of anything during the operation. The operation lasts between 2-6 hours but may take longer which means you will be under general anaesthetic for a long time.
The main risks of this type of surgery are:

Chest Infection

Because of the cut on your abdomen, you may find it difficult to breathe deeply or cough, which can lead to a chest infection. The Physiotherapist and Nurses will teach you breathing exercises to help prevent a chest infection. We also encourage you to be up and mobile as soon as possible after your operation. It is very important that you tell us if you have any pain, as this will prevent you from breathing deeply and mobilising. If you smoke, your lungs will be more sensitive to the anaesthetic. It would benefit you greatly to stop smoking or at least cut down before your operation. We are able to provide nicotine replacement therapy during your stay if required.

Blood Clots

Blood clots in the legs (deep vein thrombosis) or in the lungs (pulmonary emboli):
Moving around as soon as possible after your operation is recommended. We will give you special surgical stockings to wear whilst you are in hospital and injections to thin the blood. The Physiotherapist will show you some leg exercises to help prevent blood clots.

Wound Infection

Sometimes the wound can become infected. The Nurses will check regularly for any signs of infection and keep the wound clean and dry. If an infection does develop you may be given antibiotics. Very occasionally, the wound may open and can then take a little bit longer to heal.


A blood transfusion may be needed to replace blood lost during or after the operation.

Bile leak

The liver can leak bile from where it has been cut. Should this happen you may need to have a drain inserted to help correct this. This usually settles down without any further intervention. In very rare cases, you may require further surgery.

Liver Failure

This is very rare. The remaining part of the liver is unable to function fully. This can lead to swelling of the legs, jaundice
(yellowing of the skin) and confusion. If this occurs the team of Surgeons will support your liver with medication until it recovers and may ask the liver medical specialists (Hepatologists) to be involved in your care.

Heart problems:

Having a major operation can put stress on the heart. If you already have heart problems, the surgery may make these worse. Your team of specialists will speak to you in more detail about any heart concerns before the operation.


A small number of patients (less than 1%) who have this surgery may die within 30 days after surgery. This may be due to serious complications associated with this operation or as a result of some other medical problem. It is important to remember that you will be under the care of a specialist team of Doctors and Nurses. They will be closely monitoring your condition to make sure any complications are noticed and treated before they
become a serious risk to your life.

After your Procedure

After the Procedure

• You will wake up in the recovery room after your operation. You might have an oxygen mask on your face to help you breathe. You might also wake up feeling sleepy.

• After this procedure, most people will have a small, plastic tube in one of the veins of their arm. This might be attached to a bag of fluid (called a drip), which feeds your body with fluid until you are well enough to eat and drink by yourself.

• While you are in the recovery room, a nurse will check your pulse and blood pressure regularly. When you are well enough to be moved, you will be taken to a ward.

• Sometimes, people feel sick after an operation, especially after a general anaesthetic, and might vomit. If you feel sick, please tell a nurse and you will be offered medicine to make you more comfortable.

Later on after the procedure:

• Eating and drinking: You will be able to drink immediately after the operation and if this is all right and you do not feel sick, then you will be able to eat something.

• Getting around and about: After this procedure, you can get up and about as soon as you feel comfortable.

• When you can leave the hospital: You will be reviewed by the doctors and nursing staff on the ward after your operation. You will be allowed home after you have had something to drink and eat. We will also check that you are not feeling sick and have been able to pass urine. You will be given a supply of simple painkillers to take home. We recommend that you take these regularly for the first couple of days at home after your operation. You may feel discomfort for seven to ten days after, but simple painkillers taken by mouth are usually all that people need to enable them to be fully mobile at home. An appointment will usually be made for you to be seen in the surgeon’s rooms three to four weeks after surgery. If this is not made please call the rooms in the next business day.

• When you can resume normal activities including work: We expect you to return to normal activities in a matter of days following your procedure. You can drive again when you can comfortably make an emergency stop (generally about seven days, but must be checked in the stationary car first!). Other more vigorous activities can be resumed after two weeks as you feel comfortable.

• What happens with my dressings? All the wounds are closed with dissolvable stitches under the skin and therefore nothing needs to be done to these after the operation. Each of the wounds is covered with a small waterproof dressing which we ask you to keep intact for five days if possible. It is showerproof but will come off in a hot bath. We suggest that you get into a hot bath on day five and gently remove the dressings and leave the wound open to the air. If they rub on your clothing you may find it more comfortable to put a small Elastoplast dressing over each wound. If you have any worries about your wounds, you should contact your GP or ring the surgeon’s room.

How is this different from the traditional operation for Gall Bladder problems?

How is this different?

The actual operation is the same. The only thing that differs is the way in which we get to the gall bladder to remove it. Traditionally, we make a small cut underneath the ribs (10-15cm long). This takes longer to heal than the four little holes of keyhole surgery and the recovery is slower.

Is there a guarantee that keyhole surgery can be done?

No, there is no guarantee that the operation can be completed by keyhole surgery. If there is some technical difficulty with removing the gall bladder then a traditional cut would be needed to remove it. The time in hospital would be a little longer (about three to five days) and the recovery at home would be between six to eight weeks. The risk of having to convert to open surgery is small, about 1-3%.

Is there an alternative to surgery for gallstones?

Unfortunately, no alternative exists. The only successful treatment is to remove the gall bladder and gall stones completely. The results of this operation are very good and most patients can then return to eating a normal diet.

Can I manage without my Gall Bladder?

Yes. The gall bladder is a reservoir for bile and we are able to manage without it. Rarely do patients notice that their bowels are a little looser than before the operation but this is uncommon. You will be able to eat a normal diet after your operation, assuming that there is nothing else wrong with you.


Are there any risks?

Removal of the gallbladder is a very common and very safe procedure. However, like all operations, there are small risks involved. We believe that it is very important that you are fully aware of these risks as this is important in your understanding of what the operation involves. The possible complications below are particularly important as they can mean that you need to stay in the hospital for longer and that further operations or procedures are required.

Bleeding / Infection

Bleeding – This very rarely occurs after any type of operation. Your pulse and blood pressure are closely monitored after your operation as this is the best way of detecting this potential problem. If bleeding is thought to be happening, you will require a further operation to stop it. This can usually be done through the same keyhole scars as your first operation.

Infection – this can affect your scars (‘wound infection’) or can occur inside your tummy. Again this can happen after any type of abdominal operation. Simple wound infections can be easily treated with a short course of antibiotics. Infection inside your tummy will also usually settle with antibiotics. Occasionally, it may be necessary to drain off infected fluid from inside your tummy. This is most frequently performed under a local anaesthetic by our colleagues in the X-ray department.

Leakage of bile

Leakage of bile – When we remove the gallbladder, we put special clips on the tube that connects the gallbladder to the main bile duct draining the liver. Despite this, sometimes bile fluid leaks out. If this does occur, we have a number of different ways of dealing with this. Sometimes the fluid can simply be drained off by our colleagues in the X-ray department. In other cases, we will perform a special test called an ERCP. This is a procedure where you are made very sleepy (using sedative injections) and a special flexible camera (‘an endoscope’) is passed down your gullet and stomach to allow the doctor to see the lower end of your bile duct. A special dye allows us to see where the bile has leaked from. If the bile is leaking a plastic tube (called a ‘stent’) will be inserted into your bile duct to allow the bile to drain internally. This stent is usually removed six to eight weeks after it is put in. Rarely, if a patient develops a bile leak, an operation is required to drain the bile and wash out the inside of the abdominal cavity. This can usually be performed as a keyhole procedure.

• Injury to Bile Duct – Injury to the main bile duct draining bile from the liver to your intestine is a rare (1 per 800 cases) complication of gallbladder surgery. We use a number of techniques during the operation to prevent this from happening. If an injury occurs, it requires immediate repair so that you recover smoothly from the operation. Repair of this injury requires an open cut to be made under your ribs.

• Injury to the intestine, bowel and blood vessels – Injury to these structures can, very rarely, occur during the insertion of the keyhole instruments and during the freeing up of the gallbladder particularly if it is very inflamed. Usually, this injury can be seen and repaired at the time of the operation, but occasionally may only become clear in the early postoperative period. If we suspect that you may have sustained such an injury, a further operation will be required. This will be performed as a keyhole operation but will need conversion to an open operation if necessary.


• Blood clots in the legs (DVT) – Before your operation, you will be fitted with some stockings that you wear during your operation to help prevent blood clots from developing in the veins of your legs. You may also be given an injection in the skin of your tummy – this is a blood-thinning medicine (Heparin) that also helps prevent blood clots.

What are the risks of general anaesthesia?

In modern anaesthesia, serious problems are uncommon. Risks cannot be removed completely, but modern equipment, training and drugs have made it a much safer procedure in recent years. The risk to you as an individual will depend on; whether you have any other illness, personal factors (such as smoking or being overweight) or surgery that is complicated, long or done in an emergency. Please discuss any pre-existing medical condition with your anaesthetist.

Very common and common side effects (1 in 10 or 1 in 100 people)

Feeling sick and vomiting after surgery, sore throat, dizziness, blurred vision, headache, itching, aches, pains and backache, pain during injection of drugs, bruising and soreness, confusion or memory loss.

Uncommon side effects and complications (1 in 1000 people)

Chest infection, bladder problems, muscle pains, slow breathing (depressed respiration), damage to teeth, lips or tongue, an existing medical condition getting worse, awareness (becoming conscious during your operation).

Rare or very rare complications (1 in 10,000 or 1 in 100,000)

Damage to the eyes, serious allergy to drugs, nerve damage, death, equipment failure.

If you have any questions or anxieties about your procedure, do not hesitate to discuss these with your surgeon.

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Dr Charbel Sandroussi

Specialist in GI and General Surgery


Fax: Hours

Mon – Fri: 9:00 – 17:00