Hepatobiliary disease comes with a raft of unique considerations and concerns, particularly when it comes to surgical intervention. SASH co-founder and surgeon Dr Andrew Marchevsky says hepatobiliary surgery, depending on the patient’s condition and anatomy, can be a very difficult procedure.
“As a specialist, the most common procedures I perform are different to those of general practice. I do a lot of large liver tumour resections, portosystemic shunt surgery and cholecystectomies, as well as hepatobiliary bypass surgery.”
With hepatobiliary surgery, Andrew says two of the main perioperative complications to consider and prepare for include haemorrhaging and biliary leakage.
“For dogs with liver disease, you have to ensure they don’t have bleeding tendencies prior to surgery because it affects their ability to clot. The liver is a very vascular organ and the patient can haemorrhage profusely postoperatively,” Andrew says.
“If we identify that the patient is not coagulating properly, which occurs most commonly with biliary obstruction, we would treat them with injectable vitamin K for 12 to 24 hours prior to surgery. If you don’t have vitamin K, the liver can’t synthesise the essential clotting factors.
“Regarding bile leakage after surgery - if you have done a cholecystectomy on a very diseased gallbladder, that disease extends beyond where you’ve ligated and you are not aware of that, it can break down and leak again.”
Aside from investigating the patient’s bleeding tendencies prior to surgery, Andrew says it is also important to attend to any dehydration that may have arisen from symptomatic vomiting and checking for anaemia in advance too, in case of blood loss during surgery.
A primary anatomic consideration to note is the disparate composition of left and right side liver lobes, Andrew says.
“You need to be aware that the left side of the liver lobes are much more mobile and easily accessible. On the right side, they are very intimately associated with the major blood vessels. If you are trying to do a tumour removal on the right side, it is very difficult,” he says.
Regarding complications, Andrew says pancreatitis is a particular concern due to its proximity to the portal vein.
“Sometimes you have to manipulate the portal vein, which can cause obstruction of portal flow. This can cause partial obstruction of blood flow to the pancreas for a period of time. Being aware of this is important, as it’s not just about touching the pancreas, but about blood flow too.”
Andrew will be presenting on the “dos and don’ts” of hepatobiliary surgery at this year’s FASAVA Congress, but is also looking forward to enjoying other experts’ presentations.
“It’s always good to go and hear other surgeons talk about topics in their field. You get a different perspective and I always come away thinking, ‘That’s a good idea, I’ll try that’,” he says.
The 2017 FASAVA Congress is being held on the Gold Coast from 11 – 14 August.
Register now to ensure you don’t miss the opportunity to hear from leading veterinary experts.