Laparoscopic Inferior Flap Revision

The case

A liver transplant replaces a liver that has failed with a healthy one from a donor. The liver cleans the blood, makes the proteins that help blood clot, stores energy and makes bile to digest fat. When it fails, people become yellow (jaundice), fill with fluid, bleed and bruise easily, and can become confused. A transplant is offered for long-term liver disease such as cirrhosis, for diseases of the bile ducts, for some inherited and metabolic diseases, for some liver cancers that start in the liver, and for sudden liver failure. Each patient goes through a long medical and psychological evaluation before joining a national waiting list.

Most donor livers come from a person who has died and whose family agreed to donation. A team travels to the donor's hospital, removes the liver, cools it and brings it back on ice. Every step is checked and rechecked to make sure the donor and the recipient match. Part of a liver can also come from a living donor, or one donor liver can be split between an adult and a child, because the liver can grow back.

The recipient's operation is done under general anesthesia through a large cut under both sides of the ribs. It can last from 6 to 20 hours, and blood transfusions are common. The surgeon removes the diseased liver, sews in the new one and restores its blood flow and bile drainage. Afterward the patient goes to intensive care. They take medicines to stop the body from rejecting the new liver for the rest of their life, and they are watched closely for rejection, infection and problems with the new blood vessels or bile duct. Recovery takes months, but a successful transplant can give back years of healthy life.