Liver diseases in children often require surgical intervention when they cause severe complications, such as bile duct obstructions, liver tumors, or congenital defects. While some conditions can be managed with medications, others necessitate surgical correction or even liver transplantation.

1. Common Surgical Liver Problems in Children

A. Biliary Atresia (Blocked Bile Ducts)

• A congenital condition where the bile ducts are absent or blocked, leading to liver damage.
• It is a life-threatening condition if untreated.
• Symptoms:
  ✔ Persistent jaundice (yellow skin & eyes) beyond 2 weeks of age.
  ✔ Pale-colored stools & dark urine.
  ✔ Swollen abdomen & poor growth.
• Treatment:
  • Kasai Procedure (Hepatoportoenterostomy): A surgical bypass to restore bile flow.
  • Liver Transplant: Required if Kasai procedure fails or if liver cirrhosis develops.

B. Choledochal Cyst (Bile Duct Cyst)

• A cystic swelling of the bile ducts that can block bile flow, causing liver damage.
• Symptoms:
  ✔ Upper abdominal pain.
  ✔ Jaundice (yellow skin & eyes).
  ✔ Swelling in the abdomen.
• Treatment:
  • Surgical removal of the cyst and bile duct reconstruction.
  • Laparoscopic surgery is often preferred for quicker recovery.

C. Liver Tumors (Benign & Malignant)

Liver tumors in children can be benign (non-cancerous) or malignant (cancerous).

1. Hepatoblastoma (Most Common Liver Cancer in Children)

• A malignant tumor occurring in children under 3 years of age.
• Symptoms:
  ✔ Painless swelling in the abdomen.
  ✔ Weight loss, loss of appetite.
  ✔ Jaundice (rare in early stages).
• Treatment:
  • Surgical removal of the tumor (Partial Hepatectomy).
  • Chemotherapy (before or after surgery).
  • Liver transplant if the tumor is large or not resectable.

2. Hemangioma & Hepatic Adenoma (Benign Tumors)

• Can cause pain, bleeding, or pressure effects on other organs.
• Treatment:
  • Surgery if the tumor is large or symptomatic.

D. Liver Abscess (Pus Collection in the Liver)

• Caused by bacterial or parasitic infections (e.g., amebiasis).
• Symptoms:
  ✔ Fever, chills, right upper abdominal pain.
  ✔ Jaundice & vomiting (in severe cases).
• Treatment:
  • Drainage of the abscess (either surgically or via a catheter).
  • Antibiotics & supportive care.

E. Liver Trauma (Injury to the Liver)

• Common in accidents, falls, or blunt trauma.
• Symptoms:
  ✔ Severe abdominal pain & swelling.
  ✔ Internal bleeding (low blood pressure, pale skin, shock).
• Treatment:
  • Mild cases: Observation & supportive care.
  • Severe cases: Surgery to repair liver damage or control bleeding.

2. Diagnostic Tests for Liver Problems

👨‍⚕️ Ultrasound & CT Scan – To detect liver tumors, cysts, or abscesses.
🩸 Liver Function Tests (LFTs) – To check liver enzyme levels.
📊 MRI with MRCP – To assess bile ducts in biliary atresia or choledochal cysts.
🔬 Liver Biopsy – To diagnose liver tumors or chronic liver disease.

3. Surgical Treatments for Liver Diseases

A. Kasai Procedure (For Biliary Atresia)

• Removes blocked bile ducts and connects the liver to the intestines to restore bile flow.
• Best if performed before 8 weeks of age for higher success rates.

B. Liver Resection (Partial Hepatectomy)

• Removes diseased portions of the liver (for tumors or trauma cases).
• The liver has amazing regeneration ability and can regrow after partial removal.

C. Liver Transplantation

• Required for severe liver diseases, including:
  ✅ Biliary atresia (if Kasai fails)
  ✅ Liver failure (due to infections, metabolic diseases, or genetic disorders)
  ✅ Liver cancer (Hepatoblastoma, if non-resectable)
• Types of Liver Transplants:
  • Living Donor Liver Transplant (LDLT): A healthy liver segment is taken from a living donor (usually a parent).
  • Deceased Donor Liver Transplant (DDLT): Liver is taken from a brain-dead donor.

4. Recovery & Post-Surgery Care

🏥 Hospital Stay: 5–14 days (depending on the procedure).
🍽 Gradual reintroduction of food.
💊 Medications to prevent infection & rejection (for liver transplants).
🩺 Regular follow-ups to monitor liver function.

5. When to Seek Immediate Medical Attention?

🚨 If your child has:
❌ Persistent jaundice beyond 2 weeks of age.
❌ Severe abdominal pain & swelling.
❌ Unexplained weight loss, nausea, or vomiting.
❌ Blood in vomit or stool (signs of liver damage).