Here, the Hampshire Hospitals NHS Foundation Trust’s Basingstoke and North Hampshire Hospital liver team answer some frequently asked questions about liver surgery.
*Please note that these are general answers applying to Basingstoke practice. If you have questions or concerns about your specific diagnosis and treatment, you should chat to your specialist nurse.
Is liver surgery safe?
- Yes. Liver surgery has changed faster than any other branch of general surgery in the last twenty years and has now become relatively safe surgery if performed by experts in specialist units such as Basingstoke.
Would a transplant be better?
- No. Most transplants are done for cirrhosis and liver failure. Although the idea of “getting rid of it all” is very attractive for cancer surgery, the problem is that the strong drugs that you need to take after a transplant to prevent rejection weaken the immune system and for most types of tumour make the cancer much more likely to come back elsewhere in the body.
Will I need a blood transfusion after the operation?
- 90% of patients do not require a blood transfusion after liver surgery. For routine surgery we expect the blood loss to be around 350mls.
How long will I be in hospital?
- The average stay is around five to eight days after surgery. Younger, fitter patients often go home sooner. If any complications occur we keep you in until they are resolved. The distance you have to travel home will make a difference, as you have to be well enough for the journey.
Who will do the operation?
- All operations are performed by a consultant liver surgeon. For some straightforward cases the consultant will take a senior trainee surgeon through the operation.
What complications can occur?
- Any operation has the general risks of the anaesthetic which depend on the overall health of the patient as well as the magnitude of the surgery. There are some risks specific to liver surgery such as a leak of bile from the cut surface of the liver. This occurs in 2 or 3 people in every 100 cases that we operate on, and usually resolves without the requirement for any further surgery. A small number of patients develop a collection of infected fluid next to the surface of the liver. This is usually managed by drainage of the fluid under local anaesthetic. Occasionally after major resections patients may become slightly jaundiced, this usually resolves within a few days.
Does the liver grow back?
- Yes. The liver can regenerate after surgery. The speed of regeneration depends on the quality of the liver as well as how much has been taken. It is possible to remove up to approximately 85% of an otherwise healthy liver in a fit patient.
Can I eat the day before?
- Yes. You can eat normally. The ward nurses will tell you when to stop eating and drinking, usually six hours before your operation.
Will I experience much pain?
- The anaesthetist will discuss your pain control with you in detail. You will have either a continuous painkiller to the wound site and a button to press, which gives a small controlled dose of morphine (patient controlled analgesia, PCA), or an epidural. After a few days these will be stopped and you will be commenced on tablets. It is important that you tell the nurses or doctors if you have any pain, as our aim is for you to be pain free.
What tubes will I have?
- You will have several tubes and these all have different jobs. Some are for pain control as above; others are to drain any fluid that may collect after your operation. You will have a catheter (tube in the bladder) to drain urine to enable us to monitor your fluid balance. These tubes will be discussed with you by the doctors/anaesthetist. If you do not understand or are worried about any of them, please ask.
How big is the scar?
- The shape of the cut used for this operation is horizontal following the natural shape of the curve below your ribs. Because nerve endings are cut during the operation, this may leave you with some numbness around the scar.
When will I be allowed out of bed?
- You will be helped out of bed the morning after surgery, and the distance you walk will increase daily.
When will I be able to eat?
- You will be able to have small drinks of water in the recovery room. Once you are back to the ward you will be allowed to drink and will gradually build up your fluid intake. Usually by the second day after surgery you should be eating a light diet.
What follow up will there be after surgery and where?
- You will need to be seen within a few weeks of your discharge from hospital. This will either be with us or your local hospital, depending on how far you have to travel. Appropriate follow up visits, scans and blood tests will then be organised.
When can I drive again?
- This should not be for 3-4 weeks after surgery. You need to have your full concentration back and be able to do an emergency stop without any problems. This means the seat-belt causing minimal pain when braking sharply.
When can I left heavy things?
- About 6 weeks. You should gradually build up to your usual activity, as you feel stronger.
Can I drink alcohol after liver surgery?
- This depends on the state of your liver before surgery, how much liver you have had removed and how much you are planning to drink! Broadly speaking the answer is yes in moderation after time, but depends on the individual case and we would discuss this with you after your operation.
When can I return to work?
- This depends on your job, but most people need 2-3 months off work to fully recover from surgery and to feel physically and mentally up to coping with work. If you can return to light duties or work part-time, you may manage sooner. There is no rush and you must be sensible. Discuss it with your GP, who will be providing you with sick certificates once home.