How Does the Liver Work?

The liver is the largest gland in our body. It's a complex structure composed of cells (hepatocytes), arteries, veins, and ducts. These tissues are all organized to allow it to function as:

• A center for the transformation and production of substances useful to our organism;
• A center for the storage of "reserves";
• A center for the elimination of toxic substances;
• A barrier against aggressors transported by blood from the intestine;
• A center for the production of fluids useful for digestion (bile);

In the first 6 months of life, this organ even produces blood cells, a function it can resume under certain circumstances. Unfortunately, it's also susceptible to many tumors. Tumor cells traverse it, and some, particularly from intestinal tumors, can stop there, forming metastases. Furthermore, due to its intense activity as a factory, warehouse, and blood purifier, toxic agents and viruses can cause chronic alterations leading to tumors such as hepatocellular carcinoma and cholangiocarcinoma.

Hepatobiliary Surgery Consultation

What is the hepatobiliary surgery examination?

The hepatobiliary surgery examination is a fundamental step in preparing pediatric or adult patients diagnosed with liver and biliary tract diseases requiring surgery or transplantation. It helps plan the timing and method of the operation and places the patient on the waiting list.

The hepatobiliary surgery consultation (follow-up) monitors post-surgical phases.

What is the purpose of the hepatobiliary surgery consultation?

The hepatobiliary surgery consultation gathers information through diagnostic tests and prepares specific treatments for patients with liver diseases. These include:

• Cirrhosis due to Hepatitis C (HCV) or Hepatitis B (HBV);
• Candidates for surgery for liver and biliary tract tumors (primary liver tumors or hepatocellular carcinoma);
• Gallbladder and biliary tract tumors or cholangiocarcinoma;
• Benign pathologies such as cysts, angiomas, adenomas, and focal nodular hyperplasia;
• Secondary tumors due to metastases;
• Surgical resolution of portal hypertension, gallstones, and biliary tract stones;

The hepatobiliary surgery examination also determines when a liver transplant is necessary. Liver transplantation is considered, for example, for hepatocellular carcinoma in hepatopathy related to HCV/HBV or for end-stage liver failure.

How does the hepatobiliary surgery visit proceed?

A specialized multidisciplinary team gathers information about the patient's history and lifestyle, including diet, smoking, physical activity, current pathologies, previous interventions, family history, and medications.

Necessary laboratory tests are prescribed for a more in-depth diagnosis: blood tests, radiological examinations, and cardiological examinations.

The medical staff uses this clinical data to assess surgical risk (cardiological, thromboembolic, and hemorrhagic) to plan the safest and most appropriate operation for the patient's pathology, condition, and age.

Minimally invasive laparoscopic surgery may be used for hepatic resections, ablations, biliary tract interventions, and flow stops.

Are there any preparation rules for a hepatobiliary surgery consultation visit?

No special preparation is needed; patients should bring any previous examinations and a list of their medications.

What are the main liver diseases?

Hepatobiliary surgery treats malignant and benign hepatic pathologies, particularly metastases from colorectal and neuroendocrine neoplasms, hilar cholangiocarcinomas (Klatskin tumor), intrahepatic-extrahepatic cholangiocarcinomas, and hepatocellular carcinomas.

The main pathologies treated are:

• Hepatic angioma;
• Focal nodular hyperplasia;
• Hepatic adenoma;
• Hepatic cystadenoma;
• Simple cysts, polycystic liver disease, and Caroli's disease;
• Echinococcosis;
• Hepatocellular carcinoma;
• Extrahepatic cholangiocarcinoma;
• Intrahepatic cholangiocarcinoma;
• Gallbladder neoplasm;
• Hepatic metastases from colorectal and non-colorectal neoplasms;

What are the main treatments in hepatobiliary surgery?

For cancerous liver disease, the best hepatobiliary surgery services perform:

• Conventional and minimally invasive laparoscopic hepatic resections;
• Biliary resections and biliodigestive derivations;
• Ablative treatments (such as microwave thermoablation);
• Procedures for inducing hepatic hypertrophy (portal embolization, venous deprivation, for example);
• Hepatic chemoembolization;
• Hepatic radioembolization;
• Hepatic catheter implantation;
• TIPS (transjugular intrahepatic portosystemic shunt) for ascites and digestive hemorrhages;
• Peritoneovenous shunt (Denver shunt);

In addition to conventional interventions like major and minor hepatectomies and ultrasound-guided parenchyma-sparing resections, specific programs are carried out for:

• Extended resections (two-stage hepatectomies, ALPPS);
• Minimally invasive laparoscopic resections;

High-volume hepatobiliary surgery units prioritize patient needs, minimizing waiting times and adapting to the urgency of the diagnosis and treatment.