Liver surgery is often a critical step in the treatment of various liver-related conditions, including tumors, trauma, and certain congenital abnormalities. One of the most important surgical procedures involving the liver is hepatectomy, the partial or complete removal of the liver. When the procedure involves the removal of either the right or left lobe of the liver, it is referred to as a right or left hepatectomy.

Understanding the nuances of this procedure can help patients and their families make informed decisions during what is often a highly stressful time.

What is Right or Left Hepatectomy?

Before diving into the specifics of right and left hepatectomy, it’s important to understand the basic anatomy of the liver. The liver is divided into two major lobes the right lobe and the left lobe. The right lobe is significantly larger and is further divided into anterior and posterior segments. The left lobe is smaller and comprises medial and lateral segments.

The liver performs more than 500 vital functions, including detoxification, protein synthesis, and the production of biochemicals necessary for digestion. Given the liver’s regenerative capacity, it is possible to remove a significant portion of it, and the remaining liver tissue can still function normally and even regenerate over time.

What is Right Hepatectomy?

A right hepatectomy refers to the surgical removal of the right lobe of the liver. This procedure is usually indicated when a disease, such as a tumor or infection, is localized in the right part of the liver. It is a more extensive procedure compared to a left hepatectomy due to the larger size and complexity of the right lobe.

Common Reasons for Right Hepatectomy:

Hepatocellular carcinoma (HCC) restricted to the right lobe
Metastatic liver tumors affecting only the right lobe
Benign tumors such as hepatic adenomas or focal nodular hyperplasia
Liver trauma affecting the right lobe
Living liver donation, where the right lobe is donated due to its size and functionality

Right hepatectomy is generally considered safe in patients with a healthy liver and good overall health. However, careful preoperative assessment is necessary to evaluate liver function and ensure that the remaining liver is sufficient.

What is Left Hepatectomy?

A left hepatectomy involves the removal of the left lobe of the liver. This procedure is less complex compared to right hepatectomy and is usually associated with fewer complications due to the smaller volume of liver being removed.

Common Indications for Left Hepatectomy:

Cholangiocarcinoma located in the left hepatic duct
Benign tumors confined to the left lobe
Liver metastases from colorectal or breast cancer located in the left lobe
Congenital cysts or abscesses
Occasionally used in living donor liver transplantation, especially for pediatric recipients

Since the left lobe is smaller and less vascular, left hepatectomy generally results in a faster recovery compared to right hepatectomy.

The Surgical Procedure

Both right and left hepatectomy procedures are major surgeries that require detailed planning and surgical expertise. The operation can be performed using open surgery (traditional method) or minimally invasive techniques such as laparoscopic or robotic-assisted surgery, depending on the patient’s condition and the surgeon’s recommendation.

Preoperative Evaluation

Liver function tests
Imaging studies (CT scan, MRI, PET scan)
Portal vein embolization (PVE) may be considered before right hepatectomy to encourage the left lobe to enlarge
Assessment of cardiopulmonary fitness
Evaluation of comorbid conditions

During Surgery

The patient is placed under general anesthesia.
A large incision or several small incisions are made to access the liver.
Surgeons carefully identify and isolate blood vessels and bile ducts.
The affected lobe is removed with attention to minimizing blood loss.
The remaining liver is checked for adequate perfusion and bile flow.
Drains may be placed to collect excess fluid or bile after the operation.

The duration of surgery typically ranges from 3 to 6 hours, depending on the complexity of the case.

Postoperative Recovery

Recovery from a right or left hepatectomy involves close monitoring, especially in the first 72 hours post-surgery. Patients are usually admitted to an intensive care unit (ICU) initially for continuous observation.

Immediate Postoperative Care:

Pain management with intravenous medications
Monitoring liver function and fluid balance
Prevention of infections and other complications
Gradual introduction of fluids and food

Hospital Stay:

Most patients stay in the hospital for 7 to 10 days, though this can vary based on the extent of surgery and any postoperative complications.

Long-Term Recovery:

Full recovery typically takes 6 to 8 weeks.
Follow-up imaging to monitor liver regeneration and check for recurrence (if cancerous).
Lifestyle changes, including a healthy diet and avoidance of alcohol.
Return to normal activities is usually possible after 2 to 3 months.

Risks and Complications

Although hepatectomy is generally safe in experienced hands, it is still a major surgical procedure and comes with potential risks:

Bleeding due to the liver’s rich blood supply
Infection at the surgical site or within the abdominal cavity
Bile leakage
Liver failure, particularly if the remaining liver is insufficient
Clots in the portal vein or hepatic veins
Respiratory complications due to prolonged bed rest

The overall risk is lower when surgery is performed in a high-volume center with skilled hepatobiliary surgeons.

Conclusion

Right or left hepatectomy is a critical surgical approach used in the treatment of various liver diseases, both benign and malignant. Thanks to the liver’s incredible ability to regenerate, patients can recover well and return to a high quality of life following surgery.

Whether a patient undergoes a right or left hepatectomy depends on the location and extent of liver disease, the patient’s overall health, and the surgeon’s evaluation. Advances in surgical techniques and postoperative care have significantly improved outcomes, making hepatectomy a viable and often life-saving procedure for many individuals.

If you or a loved one has been advised to undergo a hepatectomy, consult with a liver surgery specialist or hepatobiliary surgeon to understand the risks, benefits, and expectations specific to your case.