Successful Right Hepatectomy for Right Lobe Liver Cystadenoma in a 58 Y.O. Male

Chief Complaints

A 58-year-old male patient with a body mass index (BMI) of 21 presented to the Surgical Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of intermittent pain in the right hypochondrium (upper right side of the abdomen) for the past six months.

The patient has no significant medical history, prior surgeries, chronic illnesses, or other relevant comorbidities.

On examination, the patient was conscious, coherent, oriented, and clinically stable. Clinical evaluation revealed mild tenderness over the right hypochondrium. There was no evidence of abdominal distension, ascites, or other significant abnormalities on general examination. 

Upon admission to PACE Hospitals, the Surgical Gastroenterology team conducted a detailed clinical assessment, including a review of the patient's symptoms and physical examination. A contrast-enhanced computed tomography (CECT) scan of the abdomen was performed to evaluate the liver lesion and determine its size, location, and characteristics.

The CECT abdomen revealed a 7.6 × 7.6 × 7.8 cm non-enhancing cystic lesion in the right lobe of the liver, consistent with a biliary cystic neoplasm. Routine preoperative investigations, including complete blood picture, liver function tests, renal function tests, serum electrolytes, coagulation profile, viral screening, blood grouping, and pre-anaesthetic evaluation, were performed to assess the patient's overall health and fitness for major liver surgery.

Based on the clinical and radiological findings, the patient was advised to undergo Biliary Cystadenoma Treatment in Hyderabad, India, under the expert care of the Surgical Gastroenterology Department.

After a detailed consultation with Dr. Govind Verma (Interventional Gastroenterologist and Hepatologist), along with the Surgical Gastroenterology and Hepatobiliary Surgery team, a comprehensive evaluation was performed considering the patient's six-month history of intermittent right hypochondrial pain and the imaging findings.

CECT of the abdomen demonstrated a 7.6 × 7.6 × 7.8 cm biliary cystadenoma involving the right lobe of the liver. Given the size of the lesion, the presence of symptoms, and the known potential for biliary cystadenomas to recur or undergo malignant transformation if incompletely treated, surgical management was considered the most appropriate treatment option.

Routine preoperative investigations, including complete blood picture, liver and renal function tests, serum electrolytes, coagulation profile, viral screening, blood grouping, and pre-anaesthetic evaluation, were reviewed and found acceptable for major hepatic surgery.

Based on the clinical assessment, imaging findings, and multidisciplinary team discussion, it was determined that Right Hepatectomy was the most appropriate surgical intervention to achieve complete tumour excision, relieve symptoms, prevent future complications, and preserve long-term liver function.

The patient and family members were counselled regarding the diagnosis, planned surgical procedure, expected benefits, possible risks, postoperative recovery, drain care, histopathological evaluation of the specimen, dietary advice, and the importance of regular follow-up.

Following the treatment decision, the patient was scheduled to undergo Right Hepatectomy in Hyderabad at PACE Hospitals, under the expert care of the Surgical Gastroenterology and Hepatobiliary Surgery team.

The procedure involved the following steps:

• Patient Preparation and Anaesthesia: After obtaining informed consent and completing the pre-anaesthetic evaluation, the patient was taken to the operating room and administered general anaesthesia under strict aseptic precautions.

• Abdominal Exploration: Intraoperative exploration revealed no evidence of ascites, omental deposits, or peritoneal deposits. A cystic lesion involving segments V, VI, and VII of the right lobe of the liver was identified.

• Vascular Control: The right hepatic artery and right portal vein were carefully identified, ligated, and divided to control blood inflow to the right lobe. The right hepatic vein was isolated and managed to facilitate safe liver resection while preserving the middle hepatic vein.

• Right Hepatectomy: The right lobe of the liver containing the biliary cystadenoma was completely resected. Haemostasis was achieved, and the vascular and biliary structures were securely closed using appropriate sutures.

• Omental Placement and Completion: The omentum was placed over the liver resection surface to support healing. Final haemostasis was confirmed, a surgical drain was placed, and the procedure was completed successfully without intraoperative complications.

The postoperative period was satisfactory, and the patient remained hemodynamically stable throughout the hospital stay. He was closely monitored for vital signs, liver function, drain output, wound condition, and overall clinical recovery. During hospitalization, he received supportive treatment for infection prevention, gastric protection, pain control, hydration, and overall postoperative recovery. As the patient had persistent serous drain output, he was discharged in a stable condition with the surgical drain in situ.

Upon discharge, the patient was prescribed medications for infection prevention, gastric protection, pain relief, prevention of constipation, fluid balance management, and overall postoperative recovery.

The patient was advised to follow a high-protein, low-salt diet to support recovery and liver healing. Proper wound and drain care were explained before discharge, and he was instructed to continue the prescribed medications as advised by the treating doctors. Regular follow-up with the histopathology (HPE) report was recommended to assess postoperative recovery and further management.

The patient was advised to report to the emergency ward at PACE Hospitals in case of development of symptoms such as fever, severe abdominal pain, persistent vomiting, excessive drain output, wound discharge, bleeding, yellow discoloration of the eyes or skin, abdominal swelling, or any other concerning symptoms.

The patient was advised to return for a follow-up consultation with a Surgical Gastroenterologist in Hyderabad at PACE Hospitals after 5 days.

This case highlights the successful management of a right lobe biliary cystadenoma through Right Hepatectomy. The patient had a satisfactory postoperative recovery and was discharged in a hemodynamically stable condition with appropriate dietary advice, drain care instructions, and scheduled follow-up.