Liver Disease

Liver diseases include a wide range of conditions affecting the liver, from benign tumors and cysts to liver cancer and end-stage liver failure. Early diagnosis and appropriate treatment are essential for preserving liver function and improving long-term outcomes.

The liver is one of the most important organs in the body, performing essential functions related to digestion, metabolism, and detoxification. Liver diseases can range from benign conditions such as liver cysts and hemangiomas to complex disorders including liver tumors, liver cancer, and end-stage liver disease. Early diagnosis and appropriate treatment are crucial for preserving liver function and improving patient outcomes. Dr. Prasad K. Wagle specializes in the evaluation and surgical management of a wide range of liver disorders using advanced treatment approaches.

Hepatobiliary Disorders Requiring Surgery

Hepatocellular Carcinoma (HCC)

A primary liver cancer seen mostly due to alcohol, Hepatitis B and C. Almost 80% are unresectable due to advanced cirrhosis or extra hepatic disease. Till date liver resection is the mainstay of the therapy and ranges from segmentectomies to major lobar resection based upon the size & location of the tumour as well as the volume & quality of theresidual liver. Local ablative procedure like radiofrequency ablation is done mainly for smaller tumors where in a resection cannot be done for various reasons. Other therapies like chemoembolization ,radioembolization and portal vein embolization may be required on case to case basis. Median 5 years survival for resected patients is about 30%. A small subset of patients are candidates for Liver transplant.

Hilar Cholangiocarcinomas( Klatskintumors)

These biliary tumors affect the junction of the right and left hepatic ducts sometimes infiltrating the adjacent liver and surrounding vascular structures. Patients are usually jaundiced at presentation and may require drainage by PTBD to reduce bilirubin esp if liver resection is being planned. Portal vein embolization may be required for future liver remnant hypertrophy to prevent liver failure. Median 5 years are approximately 25 %.

Surgery involves Hepatectomy with caudate lobectomy along with excision of the extrahepaticbileduct& lymphadenectomy of the Hepato duodenal region. It also entails a Hepatico jejunostomy on the opposite side.

With growing experience we have managed advanced disease particularly with vascular involvement& refused by other centres with good results.

Post Cholectystectomy Biliary Strictures

These usually stem from a poorly performed cholecystectomy (Lap/open) either because of a difficult anatomy or an overconfident surgeon or a combination of both! Associated vascular injury makes matters worse. The presentation may be in the early postoperative phase (patient usually jaundiced) with or without a bile leak or much later as a cicatrical stricture (again patient jaundiced). Reconstructive biliary surgery remains the gold standard where a Roux-en Y Hepatico jejunostomy is done. We generally advocate a prior PTBD for a road map & easier identification of ducts as well as a PTBD gram for documentation of the anastomosis.

There are the commonest space occupying lesions (SOL) of the liverthe others being

Metastasis
Hydatid cysts
Liver abscess
Adenomas
Focal Nodular hyperplasias(FNH)

Heamangiomas are benign lesions and generally warrant no therapy unless symptomatic. Lesions greater then 10cms are termed Giant haemangiomas and may cause symptoms like pain and organ compression leading to jaundice (bile duct) or vomiting (stomach). In such cases resection is required to relive the symptoms.

These are benign liver lesions that are seen not so infrequently. Liver abscesses can be amoebic (protozoal) or pyaemic (bacterial). Both have generally a dramatic presentation with patients having fever, pain in upper abdomen, elevated blood counts. USG / CT Scan are diagnostic. Treatment generally involves antibiotics & metronidazole. Percutaneous aspiration is done for large abscesses or those that are not resolving. Surgery (open/laparoscopy) is required for drainage of ruptured abscesses in the peritoneal cavity.

Hydatid cysts occur due to transmission of EchinococcusGranulosus (tapeworm) from pets through the faeco oral route. Most patients are asymptomatic wherein the cysts are detected incidentally. Dead cysts generally are calcified. Most have daughter cysts within them. Surgery is the gold standard & ranges from opening the cyst under sterile scolicidal precautions & removal of the germinating membrane, packing the cavity with omentum& under-running bile leaks if any, to cysto-pericystectomy to hepatectomy. A course of Albendazole is given for atleast 6 weeks.