Liver Biopsy; Partial Hepatectomy (resection of portion of the liver)

The Condition

Liver Biopsy is done to obtain a piece of liver that is suspected to be abnormal, so that the pathologist can make a diagnosis with the microscope. Partial hepatectomy is performed to remove an abnormal portion of your liver which may contain a tumor, infection, or some unknown disease. The body normally can tolerate loss of a portion of the liver without difficulty.

Symptoms

As indicated above, the condition that one might have can be one of many, so there are no specific symptoms that go along with this procedure. Patient may have the following non-specific symptoms:

• Weakness
• Loss of appetite
• Weight loss
• Abdominal pain
• Jaundice (yellow skin)

Procedure

This operation can be done either laparoscopically or open.  For the open procedure a large incision is made either in the midline or under the rib cage.  For the laparoscopic approach the surgeon will make about 5-6 small incisions in the abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to perform the biopsy, or to remove the portion of your liver which is diseased. Your surgeon will use a special instrument which cauterizes the liver as it is cut, so that there will be minimal bleeding. The liver specimen is removed from the abdomen through the already existing incision for the open surgery, and for the laparoscopic procedure, the specimen of liver is placed in a plastic bag and extracted through one of the small incisions after it has been enlarged.   The carbon dioxide is then released out of the abdomen through the slits, and the these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips. The patient may have a temporary drain or rubber tube exiting out through the skin.

Nonsurgical Treatment

For most tumors or masses of the liver, the best treatment is surgical removal, especially if the diagnosis is not known. In some cases, the tumor may be treated by placing a special probe into the tumor; the probe can deliver various types of energy which can destroy the tumor. The doctor should discuss with the patient all possible options.

Risks

• Infection of the skin at one of the incision sites
• Decrease in liver function
• Bleeding within the abdomen
• Collection of bile or pus within the abdomen
• Postoperative ileus (the intestines slow down/stop working for several days)
• Death

Medical Negligence

The above mentioned risks and complications are known to happen with liver biopsy and partial hepatectomy (removal of portion of the liver) and such complications do not necessarily constitute deviation from the medical standard of care.  The following examples however may be considered as medical negligence.

• Collection of bile and/or pus within the abdomen if undetected and untreated can lead to major complications including death.
• Intra-abdominal bleeding following a hepatectomy can be fast and can lead to death.