Popescu GA, Alexandrescu ST, Grigorie RT, Stoica L, Apavaloaie CA, Hrehoreţ D. GOOD TO KNOW: The ALPPS Procedure - Embracing a New Technique.
Chirurgia (Bucur) 2017;
112:332-341. [PMID:
28675369 DOI:
10.21614/chirurgia.112.3.332]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND
Hepatic resection is the only potentially curative treatment for primary liver tumors
and hepatic metastases. The most frightening postoperative complication of extensive hepatectomies
is liver failure due to insufficient future liver remnant (FLR). The ALPPS technique
(Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) effectively increased
the resectability of otherwise inoperable liver tumors (primary or secondary malignant liver tumor)
by achieving a rapid and an effective hypertrophy of the FLR, which lowers postoperative liver
failure risk.
AIM
To present the ALPPS classic right trisectionectomy and its technical variants which were
invented to decrease the high rate of post-operative morbidity and mortality, reported in early case
series.
TECHNIQUE
ALPPS involves two stages. The first surgical procedure consists in the ligation of the right
portal branch and the partition of the liver at the site of the falciform ligament (insitu splitting). In
contrast to a classical hepatectomy, the tumoral hemiliver is left in situ and remains vascularized by the
right hepatic artery only. The biliary and systemic venous drainages represented by the right biliary
duct and respectively the hepatic veins, are preserved. The second step of the procedure is usually
performed within 7 to 15 days after the firststage. The tumoral hemiliver is removed by sectioning the
right hepatic artery, the biliary duct and the systemic venous pedicle.
Conclusions
The ALPPS technique is a therapeutic method for inoperable liver tumors by standard
methods of hepatectomy ± portal vein ligation (PVL). By careful patient selection and technical
adjustment to the particular conditions of each case, better outcomes have been achieved, leading
toan increasing number of surgeons who perform ALPPS.
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