Liver resection may be indicated in abdominal trauma, and in tumours of the liver. However, in many cases of malignant tumours only complete removal of the liver and liver transplantation is curative. Localised metastases may also be resected.
The liver is composed of several segments, as defined by the blood supply and drainage, this is important in liver resection. The hepatic artery and portal vein each have a left and right branch and these supply the left and right hemi-livers respectively. The left hemi-liver comprises of the left lobe and the caudate and quadrate lobes; together these form four segments. The right hemi-liver comprises of the remainder of the right lobe and is also further divided into four segments (see Fig. 5.3).
This means that right hepatectomy, left hepatectomy and extended right hepatectomy (right lobe plus caudate and quadrate lobes) or individual segments may be resected. The liver is first mobilised from its peritoneal attachments. The appropriate vessels for the segment(s) are ligated and divided before the segment(s) are dissected away from the remainder of the liver. Careful identification and ligation of biliary ducts and smaller vessels is required to reduce blood loss and therefore morbidity and mortality. Drainage is required postoperatively, to prevent bile from pooling intra-abdominally.