The liver and biliary tract
The liver performs over 500 functions, including:
- Filtering and removing toxins from the blood
- Producing bile for fat digestion
- Storing energy as glycogen
- Producing essential proteins for clotting
- Metabolizing medications
The biliary tract consists of ducts that transport bile from the liver to the intestine, passing through the gallbladder where it is stored.
When is hepatobiliary surgery needed?
Liver and biliary tract surgery may be indicated in different situations:
Primary liver tumors
- Hepatocellular carcinoma: Cancer that originates in the liver itself
- Intrahepatic cholangiocarcinoma: Cancer of bile ducts within the liver
Liver metastases
- Tumors that have spread to the liver from another origin
- Most common: from colon, rectum, pancreas, stomach, breast
- In selected cases, surgery can be curative
On the liver metastases page we explain when they can be operated on.
Biliary tract tumors
- Perihilar cholangiocarcinoma (Klatskin tumor): At the confluence of bile ducts
- Distal cholangiocarcinoma: In the lower part of the bile duct
- Gallbladder cancer
Types of liver surgery
The techniques the team uses are described in liver resections.
The type of intervention depends on tumor location and size:
Partial hepatectomy
Removal of a part of the liver containing the tumor:
- Segmentectomy: Removal of one or two segments
- Lobectomy: Removal of the right or left lobe
- Major hepatectomy: Removal of more than 50% of the liver
A unique characteristic of the liver: It is the only organ capable of regenerating. After a hepatectomy, the remaining liver can grow to almost its original size within weeks to months.
Preoperative evaluation
Before surgery, the team needs to evaluate:
- Liver function: Blood tests, specific tests
- Liver volume: CT or MRI to calculate the remaining liver
- General condition: Ability to tolerate surgery
- Tumor extent: Detailed imaging studies
Portal vein embolization
In some cases, when the remaining liver is small, portal vein embolization can be performed before surgery:
- Minimally invasive procedure
- Stimulates growth of healthy liver before surgery
- Performed weeks before the intervention
It is carried out together with interventional radiology. We describe it in combined techniques with interventional radiology.
Preparation for surgery
- Nutritional optimization, especially protein intake
- Control of associated conditions (diabetes, hypertension)
- Alcohol abstinence if applicable
- Stop smoking
- Respiratory physiotherapy
- Psychological preparation and resolving questions
Surgery and postoperative period
During the intervention
- Duration: 3-6 hours depending on complexity
- Can be performed by open surgery or laparoscopically depending on the case
- Very precise bleeding control techniques
Immediate postoperative period
- Initial stay in ICU or intermediate care unit
- Abdominal drains
- Close monitoring of liver function
- Progressive resumption of eating
- Early mobilization
Usual hospitalization: 5-10 days, depending on the extent of surgery and progress.
Possible complications
Transient liver failure
When the remaining liver needs time to adapt to new demands:
- Elevated bilirubin (jaundice)
- Clotting alterations
- Usually temporary and progressively recovers
Bile leak
Bile leakage from the liver's cut surface:
- Detected through drains
- Most resolve spontaneously
- Sometimes requires additional procedures
Other complications
- Postoperative bleeding
- Wound infection or abdominal abscess
- Pulmonary complications
Recovery and life after surgery
Recovery depends on the amount of liver removed:
- First weeks: Fatigue, abdominal discomfort, slower digestion
- First month: Progressive energy recovery
- 2-3 months: Liver regeneration nearly complete
Recommendations
- Balanced diet, avoid excess fat initially
- Strict alcohol avoidance
- Do not take medications without consulting (the liver metabolizes them)
- Progressive physical activity as tolerated
- Regular medical follow-up
Oncological follow-up
Long-term follow-up includes:
- Periodic imaging tests (CT, MRI)
- Tumor markers according to tumor type
- Liver function monitoring
- Evaluation of complementary treatments if indicated
A message of hope
Some liver tumors that were once considered inoperable can now be operated on, sometimes after a portal vein embolization that makes the healthy liver grow. Because the liver regenerates, a large part of it can be removed. Many patients overcome the disease and recover their quality of life.
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