Prior to liver transplantation, various things need to be considered by the surgical team. First is the over-all health status of the patient. The surgery can not push through if the patient is not well as having an infection. Second, the surgeon must be widely acquainted with the blood supply and anatomy of the patient’s liver. Hence, the various imaging techniques are done prior to the liver transplant such as magnetic resonance (MR) angiography, which is a very helpful method of visualizing the vessels involved in liver transplant (Edelman et al.
, 1991). The duration of a liver transplant is usually 6 to 12 hours so fluid supply is installed through intravenous lines (IV) or a central line that is inserted under the right clavicle. These lines serve as instruments for the administration of fluids, blood transfusions, and medicines. The normal functions of the patients body is carried on during and several days after the surgical procedure through the utilization of various tubes. These tubes are the breathing tube; nasogastric tube; catheter; and, blood and fluid draining tubes.
A tube inserted in the trachea and connected to a ventilator aide the surgical patient is breathing during the operation until about two days post operation. The pipe called nasogastric tube is inserted through the nose to the stomach to drain this organ’s secretion and is only removed when the bowel function is restored. Urine drainage is made possible by the insertion of catheter in the urinary bladder. The pooling of blood and fluids in the abdomen is prevented by the installation of three tubes in the area around the liver which will not be removed for about one week.
And lastly, a tube known as T-tube is placed in the bile duct to draw off bile (health-cares. net). Liver transplant is a bloody surgical procedure. Death of the organ to be transplanted, the patient, and the donor can occur if appropriate bleeding or hemorrhage control techniques are not done especially during resection or removal of the liver to be transplanted. A traditional method used to prevent bleeding during liver resection is the liver parenchyma finger fracture. This technique is the severing of liver parenchyma along with inflow occlusion.
The surgical instrument that is of high value for this technique is the Kelly clamp (Rivera, 2007). Another technique used for liver resection is the ultrasonic dissection which is the modern standard for this procedure. Ultrasonic energy is utilized to section the liver parenchyma; and then, blood vessels and ducts are exposed through aspiration before these structures are ligated. A significant decrease in blood loss is observed using this technique as compared to finger crushing technique. The third resection bleeding control technique is called water jet.
This institutes a water propulsion dissector to section the liver parenchyma before revealing the blood vessels and bile ducts. The next technique is known as harmonic scalpel. The latter enables the destruction of fewer blood vessels during the liver transaction. Capillaries and venules are sealed using shears that are activated with ultrasonic energy (Rivera, 2007). The fifth technique for resection bleeding control utilizes an instrument named ligasure. This instruments mechanism employs bipolar radiofrequency energy that changes vessel wall’s collagen and elastin composition, and compression.
The maximum size of blood vessels that can be closed up with this technique is 7mm. There are hesitations though about this techniques’ capacity to seal large bile ducts. Other resection bleeding control techniques are tissueling, which applies saline-linked radiofrequency energy; and radiofrequency assisted liver transaction (Rivera, 2007). Blood transfusion is a probable occurrence during liver transplantation since it is a major surgical procedure. Ready blood supply for the transfusion must be prepared prior to the surgery.
The liver transplant as a major operative procedure necessitates the involvement of surgeons, other doctors, nurses, and anesthetists. The surgery commences with the incision of the upper abdomen specifically under the ribs; and, then the diseased part or entire liver is transected and removed. The healthy liver from the donor is then positioned as well as the connection of blood vessels and bile ducts restored. After this the stitching of the incision follows before the application of wound dressing (“Liver Transplantation”). Treatments involved
Post- surgical care is given to the liver transplant patient after the operation. During this period the patient is closely monitored for infection and transplant rejection. The usual period of medical treatment to transplant patients is 3 months. In these three months, the patient is given appropriate antibiotics; antifungal drugs; antacids; and immunosuppressants to prevent the rejection of the transplanted organ. Rejection of the liver transplant despite the administration of various immunosuppressive medicines will necessitate a second transplant procedure.
Aside from transplant rejection, the development of medical conditions like hypertension; diabetes; and hypercholesterolemia are the post-surgical risks of liver transplantation (“Liver Transplantation”).
Works Cited American Liver Foundation. September 2007. “Liver transplant”. 31 March 2009 <http://www. liverfoundation. org/education/info/transplant/>. Edelman, Robert R. , Jenkins, Roger L. , Stokes, Kenneth R. , Clouse, Melvin E. , Lewis, W. David, Finn, J. Paul, Longmaid, H. Esterbrook, Kane, Robert A. , and Mattle, Heinrich P.
“Liver transplantation: MR angiography with surgical validation”. Radiology, 1991. 30 March 2009 <http://www. faqs. org/abstracts/Health/Liver-transplantation-MR-angiography-with-surgical-validation. html> Genyk, Yuri. “Surgical Innovations in Liver Transplantation”. Liver Newsletter, University of Southern California (USC) The Liver Transplant Surgery Program and Center for Liver Disease. 31 March 2009 <http://www. surgery. usc. edu/divisions/hep/livernewsletter-surgicalinnovationsinlivertransplantation. html>.
“Liver Transplantation”. Globe health Tours, Globe Health Tours Ltd. Company, 2007. 31 March 2009 <http://www. globehealthtours. com/directory/Liver_Transplantation> Medline Plus. “Liver Transplantation” 31 March 2009 <http://www. nlm. nih. gov/medlineplus/livertransplantation. html> “Liver Anatomy and Physiology” Professional Ultrasound Services, 2008. 31 March 2009 <http://prosono. ieasysite. com/patho_notes_liver_anat_physiol. pdf> “Liver Statistics” NHS Blood and Transplant, 2009. 31 March 2009 <https://www. uktransplant.
org. uk/ukt/statistics/calendar_year_statistics/liver/liver. jsp? page=&view=transplant> Rivera, EF. “Surgical Techniques for Liver Transaction”. 2007. Hepatobiliary surgery and liver transplantation. 30 March 2009 <http://drfloresriveraenglish. wordpress. com/2007/10/10/surgical-techniques-for-liver-transection/> Torphy, JM. , Lynm, C. , and Glass, RM. “Liver Transplantation”. Journal of the American Medical Association, 2006, 295 (18): 2008. 31 March 2009 <http://jama. ama-assn. org/cgi/reprint/295/18/2208. pdf>.