-Hepatectomies can be performed by laparotomy or laparoscopy depending on the stage, number, size and location of the liver tumour.
-The oncological pathology is very wide and can consist in major hepatectomy (> 3 hepatic segments), minor hepatectomy and tumorectomy in the form of wedge resection. In selected cases, the treatment of the hepatic lesions can be performed by local destruction by thermoablation. All these gestures can be combined during the same intervention.
-The preoperative assessment is very important to achieve a good result, in the context of a complex surgery.
-Special attention should be paid to the administration of Paracetamol which is well known as hepatotoxic. The accepted safety doses after hepatic resection are <2g / day. Pain relief with opioids or morphine is desirable rather than increasing the dose of Paracetamol.
• Day1-the patient is allowed to have a TBB or even a light diet depending on his abdominal condition. A control blood test with liver function tests is essential. The drain is monitored as well as the parameters. The urinary catheter can be kept if the patient presents with abdominal pain during mobilization, for his comfort. If the hepatectomy has been performed by laparotomy, an abdominal belt is indicated to reduce wall pain upon mobilization. Be careful that the abdominal belt is too tight to limit respiratory movement and promote pulmonary atelectasis.
• Day2-A control blood sample is taken, the patient is stimulated to mobilize unless a PCA-type epidural is in place. In this case, the bladder catheter will be kept until the catheter is removed.
•> Day3– Clinico-biological monitoring
• Day4– The removal of the drain will be taken into consideration if it remains clean and the general condition of the patient is favourable.
• Day5-7– Depending on the patient’s progress and in the absence of complications, discharge may be considered during this period
• Bleeding – manifested by externalization of blood at the level of the drain and general signs (pallor, tachycardia, tachypnea, dizziness, and in a more advanced state confusion, state of shock). Depending on the extent of the bleeding, the patient will require a transfusion and / or reoperation.
• Liver failure – a very serious complication present in major hepatectomies, and related to the size and condition of the remaining liver (risk is higher if liver resection is performed on a cirrhotic liver). With limited resection, hepatic failure is usually transient and not very severe unless it persists beyond the fifth day.
• Biliary fistula – evidenced by the presence of bile in the drain. If the flow is low, conservative treatment is sufficient, usually will dry up spontaneously. In case of high flow> 200cc / 24h there is the possibility of endoscopy with the realization of a cholangiography to identify the leak, with the realization of a sphincterotomy to reduce the pressure in the biliary tree and/or the installation of a temporary stent.
• Intra-abdominal abscess – can appear in context of hematic or infected bilious collection. Clinically the patient is feverish, dyspnoeic, he presents an increase in abdominal pain or an intestinal ileus. The abdominal CT scan makes it possible to diagnose and even treat an abscess by percutaneous drinage under local anaesthesia. Antibiotic therapy should be considered.
• Pulmonary complications – acute respiratory distress syndrome (ARDS), acute lung oedema (OAP), pneumonia, pulmonary embolism or pleural effusion. Treatment consists of antibiotic therapy, oxygen therapy, respiratory physiotherapy, aerosols, or in more severe cases ventilatory support.