What is Open Hepatic Lobectomy or Segmentectomy

Open Hepatic Lobectomy or Segmentectomy is surgery to remove a part of the liver. This surgery is done when a part of the liver is diseased. The liver is the largest organ in the body and it is involved in many important bodily functions. The liver contains two main lobes, right and left.

Each lobe can be divided into segments. In a lobectomy, the entire right lobe or left lobe is removed. In a segmentectomy, one or more parts of the lobe (segments) are removed. After the diseased section is removed, the liver can regrow healthy liver tissue in a matter of weeks.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Leaking from the surface of the liver.
• Blood clot.
• Scarring.

The following problems may also occur, but they are rare:

• Liver failure.
• Fluid buildup (ascites).
• Inflammation.
• Fatty liver (steatosis).
• Excess tissue (fibrosis).
• Need for blood transfusion.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• You may need to have blood tests and imaging tests done. Imaging tests may include a CT scan or MRI of the liver.
• Do not smoke for as long as possible before the surgery. Smoking can increase the chances of a healing problem after surgery. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital.
• Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• Small monitors will be connected to your body. They will be used to check your heart, blood pressure, and oxygen level.
• An IV tube will be inserted into one of your veins. Fluids and medicine will flow directly into your body through the IV tube.
• You will be given a medicine to make you fall asleep (general anesthetic).
• An incision will be made in your abdomen. Ultrasound imaging will be used to confirm the area of your liver that needs to be removed.
• The surgeon will access your liver by hand and will use a device to mark the section to be removed.
• Using a small scalpel, electric cutting device, or ultrasonic cutting device, the surgeon will separate the two lobes or the appropriate segments.
• The diseased lobe or segment will be removed.
• Your abdomen will be closed with stitches (sutures), staples, or glue.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will wake up groggy and may feel nauseous for a short time because of the anesthetic.
• You will receive medicines to control pain.
• You will be encouraged to get up and move around about three times a day.

Open Hepatic Lobectomy or Segmentectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain and discomfort.
• Change in appetite while recovering.
• Decreased energy.

Follow these instructions at home:

Activity

• Get plenty of rest, but move around frequently for short periods or take short walks as told by your health care provider. Gradually increase your activities.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• For 6–8 weeks or as long as told by your health care provider:
  • Do not lift anything that is heavier than 10 lb (4.5 kg).
  • Avoid activities that require a lot of energy.
• Do not drive until your health care provider approves.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Do not use any ointments or creams on your incision unless your health care provider approves.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.

Eating and drinking

• Drink enough fluid to keep your urine clear or pale yellow.
• Follow any instructions from your health care provider about eating.
• Maintain a healthy diet. This will help you gain strength and will promote a smooth recovery.
• To help prevent constipation, eat foods that are high in fiber, such as whole grains, fruits, and vegetables.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These slow down the healing process. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You are feeling nauseous.
• You are vomiting.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever.
• You have chills.
• You have pain, bloating, pressure, or cramping in the abdominal area.
• You have other new symptoms.

Get help right away if:

• Your abdominal pain does not go away or it becomes severe.
• You feel your heart beating rapidly or skipping beats.
• You have chest pain.
• You are suddenly dizzy or short of breath.