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World J Gastrointest Surg. May 27, 2013; 5(5): 146-155
Published online May 27, 2013. doi: 10.4240/wjgs.v5.i5.146
Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives
Shahid G Farid, K Rajendra Prasad, Gareth Morris-Stiff
Shahid G Farid, Department of General Surgery, Northampton General Hospital, Northampton, NN1 5BD, United Kingdom
K Rajendra Prasad, Hepatobiliary and Transplantation Unit, St James University Hospital, Leeds, LS9 7TF, United Kingdom
Gareth Morris-Stiff, Department of Surgery, Belfast City Hospital, Belfast, BT12 6BA, Ireland
Author contributions: All authors have contributed significantly to the manuscript.
Correspondence to: Shahid G Farid, MD, MRCS, Department of General Surgery, Northampton General Hospital, Cliftonville Road, Northampton, NN5 5HQ, United Kingdom. sfarid@doctors.net.uk
Telephone: +44-113-2065921 Fax: +44-113-2448182
Received: November 28, 2012
Revised: February 20, 2013
Accepted: March 28, 2013
Published online: May 27, 2013
Abstract

Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients.

Keywords: Hepatic surgery, Terminology postoperative management, Complications, Training

Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.