Liver Resection (Hepatectomy): What to Expect Before, During, and After Surgery

Hello, I’m Dr. Ashish George, a liver transplant and HPB surgeon based in Delhi. Over my 15 years in surgery, I’ve guided thousands of patients and their families through the complexities of liver procedures. I understand that a recommendation for liver surgery can be overwhelming, filled with uncertainty and questions. My goal with this guide is to demystify the process for you.

A liver resection, or hepatectomy, is a surgical procedure to remove a portion of the liver. It is a highly specialized operation performed to treat conditions ranging from cancerous tumors to benign growths, offering a path toward recovery and long-term health.

This entire procedure is built on one of the most incredible facts of human biology: the liver’s unique ability to regenerate. A healthy liver can grow back to its original size, often within just six to eight weeks after a part of it is removed. This remarkable power is what makes a hepatectomy liver resection in Delhi not just possible, but a safe and effective treatment.

Let's walk through this journey together, step by step, so you know exactly what to expect before, during, and after your surgery.

Before Your Surgery – Preparing for a Successful Outcome

The time leading up to your operation is just as important as the surgery itself. This phase is all about careful evaluation, planning, and preparation to ensure the best possible outcome.

What is a Liver Resection and Why is it Performed?

A hepatectomy involves the surgical removal of a diseased or damaged part of the liver. The primary goal is to eliminate the problem while preserving as much healthy liver tissue as possible.

This surgery is recommended for several conditions:

• Malignant (Cancerous) Tumors: This is the most common reason for a liver resection.
  • Primary Liver Cancers: These are cancers that start in the liver itself, like Hepatocellular Carcinoma (HCC) or Cholangiocarcinoma (bile duct cancer). For these, surgery offers the best chance for a cure.
  • Secondary (Metastatic) Cancers: This is cancer that has spread to the liver from another organ, most commonly colorectal (bowel) cancer. Removing these tumors can significantly improve a patient's prognosis.
• Benign (Non-Cancerous) Conditions:
  • Tumors and Cysts: Growths like hepatic adenomas, hemangiomas, or large cysts may need to be removed if they cause symptoms like pain, are at risk of rupturing, or bleed.
  • Infections or Damage: Liver abscesses (collections of pus) that don't respond to other treatments or damage from a traumatic injury might require surgery.
• Living Donor Liver Transplantation: A healthy person can donate a portion of their liver to someone in need. The surgery performed on the donor is a partial hepatectomy.

The Critical Pre-Operative Evaluation: Are You a Candidate?

Before we proceed, my team and I conduct a meticulous evaluation. This isn't just a formality; it's a crucial safety step. The decision to operate depends on answering a few key questions :

1. Is your overall health strong enough for a major operation?
2. Is the tumor located where it can be safely removed?
3. For cancer patients, has the disease spread outside the liver?
4. Most importantly, will the remaining part of your liver—the "future liver remnant"—be large and healthy enough to function while it regenerates? 

To answer these, we perform a series of tests:

• Imaging Tests: High-resolution CT scans or MRIs give us a detailed 3D map of your liver, showing the tumor's exact size and location in relation to critical blood vessels.
• Liver Function Tests: These simple blood tests tell us how well your liver is working right now.
• General Health Check: An electrocardiogram (ECG) for your heart and a chest X-ray for your lungs ensure you are fit for anesthesia.

In some complex cases, we might use advanced techniques like Portal Vein Embolization (PVE), a procedure that encourages the healthy part of your liver to grow before surgery, making the operation safer.

Why Your Pre-Surgery Prep is More Important Than You Think

Your active participation in the weeks before surgery can dramatically improve your recovery. Think of it as training for an important event. Modern surgical protocols, known as Enhanced Recovery After Surgery (ERAS), emphasize the patient's role in their own care.

Here is your pre-surgery checklist:

• Lifestyle Changes:
  • Stop Smoking: This is critical. You should stop smoking at least two to four weeks before your operation. Smoking impairs healing and dramatically increases your risk of post-operative lung infections like pneumonia.
  • Avoid Alcohol: Stop drinking all alcohol for at least one week, and preferably four, before surgery. This gives your liver the best possible chance to prepare and recover.
• Nutrition and Diet:
  • Eat Well: Focus on a balanced, high-protein diet to build your strength. I often recommend nutritional supplement drinks like Ensure or Boost for the five days leading up to surgery.
  • The Day Before: You will likely eat a normal breakfast and lunch, then switch to a clear liquid diet. You will be given specific fasting instructions, typically to stop all food and drink after midnight. It is vital to follow these exactly.
• Gentle Exercise:
  • Stay Active: Walking for 30 to 60 minutes each day is one of the best things you can do. It builds stamina and is proven to lead to a faster, smoother recovery.
• Medication Adjustments:
  • Tell Us Everything: We need to know about every medication you take, including over-the-counter drugs and herbal supplements.
  • Blood Thinners: If you take medications like Aspirin, Warfarin, or Plavix, you must tell us. These will need to be stopped several days before surgery to prevent bleeding.
• Skin Preparation:
  • You will be asked to shower with a special antiseptic soap the night before and the morning of your surgery to reduce bacteria on your skin. Please do not shave the surgical area yourself, as this can increase infection risk.

During Your Surgery – In the Hands of the Surgical Team

On the day of the operation, you will be cared for by a dedicated team of surgeons, anesthesiologists, and nurses. While it can be an anxious time, knowing the process can help.

The Day of Your Operation

After arriving at the hospital and checking in, you’ll be taken to a pre-operative area. A nurse will review your history, and an intravenous (IV) line will be placed in your arm for fluids and medication. You will meet with me and the anesthesiologist one last time to go over the plan and answer any final questions.

Once in the operating room, the anesthesiologist will give you medication through your IV. You will fall into a deep, painless sleep and will be completely unaware of the procedure. A breathing tube will be placed after you are asleep, and your vital signs will be monitored continuously throughout the surgery.

Surgical Approaches: Open vs. Minimally Invasive

The choice of surgical technique depends on many factors, including the tumor's size and location. The ultimate goal is always the complete and safe removal of the diseased tissue.

• Open Hepatectomy (Traditional): The surgeon makes a single, longer incision in the upper abdomen to directly access the liver. This approach is often necessary for large or complex tumors located deep within the liver.
• Minimally Invasive Hepatectomy (Laparoscopic or Robotic): This "keyhole" surgery is performed through several small incisions. A tiny camera (laparoscope) and specialized instruments are used to perform the resection. This is often suitable for smaller tumors on the liver's surface and generally leads to less pain and a faster recovery.

Here is a simple comparison:

Feature	Open Liver Resection	Minimally Invasive Resection
Incision	One long incision	Several small "keyhole" incisions
Best For	Large, deep, or complex tumors	Smaller, surface-level tumors
Hospital Stay	5 to 7 days, sometimes longer	1 to 5 days
Recovery Time	6 weeks to 3 months	2 to 6 weeks
Key Benefits	Direct access for complex cases	Less pain, faster recovery, better cosmetic result

A Step-by-Step Overview of the Hepatectomy Procedure

A liver resection is a complex operation that typically takes between two and six hours. The general steps are as follows:

1. Exposure and Assessment: After the incision, I carefully examine the liver. I often use an intraoperative ultrasound probe directly on the liver's surface to get a real-time map, confirming the tumor's location and its relationship to major blood vessels that must be protected.
2. Controlling Blood Flow: I meticulously identify and isolate the specific blood vessels (branches of the hepatic artery and portal vein) that supply the portion of the liver to be removed. These are carefully tied off and divided.
3. Dividing the Liver Tissue (Parenchymal Transection): This is the core of the operation. Using advanced energy devices, I divide the liver tissue itself. These tools allow me to separate the liver cells while preserving the small blood vessels and bile ducts within, which are then individually sealed and cut.
4. Final Detachment and Removal: The final major blood vessel, the hepatic vein, which drains blood from the resected section, is divided. The diseased portion of the liver is now free and is removed from the body.
5. Closure: I thoroughly inspect the cut surface of the remaining liver to ensure there is no bleeding or bile leakage. A temporary surgical drain may be placed to collect any fluid, and the abdominal incisions are closed.

After Your Surgery – Your Path to Recovery

The post-operative period is when your body begins the amazing work of healing and regeneration. Your active participation is crucial during this phase.

The First Few Days: Your Hospital Stay

Immediately after surgery, you will be taken to a Post-Anesthesia Care Unit (PACU) or recovery room. Depending on the extent of your surgery, you may spend the first 24 hours in an Intensive Care Unit (ICU) for close monitoring.

• Tubes and Drains: It is normal to wake up with several tubes, all of which are temporary. These may include IV lines for fluids, a urinary catheter, and a surgical drain near your incision.
• Pain Management: We will keep you comfortable. Pain is managed effectively with methods like a Patient-Controlled Analgesia (PCA) pump, which lets you administer medication yourself, or an epidural catheter that provides continuous numbing. After a day or two, you will switch to oral pain medication.
• The Most Important Post-Surgery Activity: Walking! This might sound surprising, but getting out of bed and walking is one of the most critical things you can do. We will help you get up and moving, often as early as the day after surgery. Walking helps prevent blood clots, keeps your lungs clear, and stimulates your digestive system.
• Breathing Exercises: You will be taught how to use an incentive spirometer, a simple device to help you take deep breaths. Using this regularly helps prevent pneumonia.
• Eating and Drinking: You will start with clear liquids and gradually progress to solid foods as your system "wakes up".

Your hospital stay can range from 1-5 days for a minimally invasive procedure to 5-7 days for an open surgery.

Returning Home: Your First Six Weeks and Beyond

Full recovery takes time, typically four to eight weeks. It's normal to have good days and bad days. Be patient with yourself.

Here is a general timeline for your recovery at home:

Timeframe	Activity & Lifting	Diet & Nutrition	Key Milestones & Restrictions
Weeks 1-2	Focus on rest and short, frequent walks. Do not lift anything heavier than 10 lbs (about 4.5 kg).	Eat small, frequent, low-fat meals. Stay hydrated. Use stool softeners to prevent constipation from pain medication.	Pain will gradually lessen. Keep your incision clean and dry. NO DRIVING. NO ALCOHOL.
Weeks 3-6	Gradually increase your walking distance. Continue the lifting restriction. Avoid strenuous activities like vacuuming.	Your appetite should improve. Continue with a balanced diet.	You may be able to return to a desk job. You can likely resume driving once you are off narcotic pain medication. NO ALCOHOL.
After 6-8 Weeks	You can usually resume most normal activities and moderate exercise. Your surgeon will clear you to lift heavier items.	You can return to your normal diet. Alcohol may be reintroduced in moderation, but only with your surgeon's approval.	Your liver has largely regenerated. Your first follow-up appointment is complete.

Call my office immediately if you experience signs of infection like a fever over 101.5°F, increasing redness or drainage from your incision, or worsening abdominal pain.

Understanding the Risks and Potential Complications

While liver resection is very safe when performed by an experienced team, it is a major operation with potential risks.7 We take every precaution to prevent them.

Potential complications include:

• Bleeding: The liver has a rich blood supply, and bleeding is a risk. In some cases, a blood transfusion may be needed.
• Infection: Infections can occur in the wound, lungs (pneumonia), or abdomen and are treated with antibiotics.
• Bile Leakage: Sometimes, bile can leak from the cut surface of the liver. Most leaks resolve on their own or with a temporary drain.
• Blood Clots: Immobility increases the risk of clots in the legs (DVT). Early walking and compression stockings are key preventative measures.
• Liver Failure: This is the most serious but also the rarest complication. Our extensive pre-operative evaluation is specifically designed to ensure the remaining liver is sufficient to prevent this.

Your Next Step on the Path to Recovery

The journey through a liver resection is a partnership between you, your family, and your medical team. It requires advanced surgical skill, but just as importantly, it requires your commitment to the preparation and recovery process. The liver's incredible ability to regenerate is the biological miracle that makes this life-saving surgery possible.

Choosing a surgical team with deep experience in these complex procedures is paramount. As a specialist in hepatectomy liver resection in Delhi, my team and I are equipped with the expertise to manage the full spectrum of liver conditions and provide you with comprehensive, personalized care.

I hope this guide has provided clarity and confidence for the road ahead. Please write down any other questions you have and bring them to your consultation.

To book an appointment with my team and me at Fortis Hospital, Shalimar Bagh, Delhi, please call +91 93101 39800 or visit our website to learn more.

Frequently Asked Questions (FAQs)

Q: How much of my liver can be removed?

A: If your liver is healthy, a surgeon can safely remove up to 75-80% of it. If you have an underlying condition like cirrhosis, the amount is smaller.

Q: How long does it take for the liver to grow back?

A: Regeneration begins within days, and the liver typically returns to its near-original size and function in about six to eight weeks.

Q: Will I be in a lot of pain?

A: You will have pain, but we will manage it effectively. The most significant discomfort usually improves within the first week or two.

Q: When can I eat normally again?

A: Most patients start with liquids the day after surgery and are eating solid food within a few days. Your appetite may be reduced for a few weeks, so smaller, frequent meals are helpful.

Q: Can the cancer come back after surgery?

A: Yes, there is a risk of recurrence. This is why long-term follow-up with regular scans and blood tests is a critical part of your care plan after surgery for cancer.