Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Tips and Tricks
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Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Tips and Tricks Fernando A. Alvarez & Victoria Ardiles & Rodrigo Sanchez Claria & Juan Pekolj & Eduardo de Santibañes Received: 26 July 2012 / Accepted: 13 November 2012 / Published online: 27 November 2012 # 2012 The Society for Surgery of the Alimentary Tract
Abstract Background Posthepatectomy liver failure is the most severe complication after major hepatectomies and it is associated with an insufficient future liver remnant (FLR). Associating liver partition and portal vein ligation (PVL) has recently been described as a revolutionary strategy to induce a rapid and large FLR volume increase. We aim to describe our surgical technique, patient management, and preliminary results with this new two-stage approach. Technique During the first stage, liver partition and PVL of the diseased hemiliver are performed. The completion surgery is carried out after volumetric studies have demonstrated a sufficient FLR and provided the patient is in good condition. This is usually achieved after 7 days. In the second step, the patient undergoes a completion surgery with right hepatectomy, right trisectionectomy, or left trisectionectomy. Results Fifteen patients with advanced liver tumors were treated. Nine patients were males and the mean age was 54 years old. The mean difference between the preoperative and postoperative FLR volume was 303 ml (p
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