Right Portal Vein Ligation Combined With In Situ Splitting Induces Rapid Left Lateral Liver Lobe Hypertrophy Enabling 2-Staged Extended Right Hepatic Resection in Small-for-Size Settings

Schnitzbauer, Andreas A.; Lang, Sven A.; Goessmann, Holger; Nadalin, Silvio; Baumgart, Janine; Farkas, S.; Fichtner‐Feigl, Stefan; Lorf, Thomas; Goralcyk, Armin; Hörbelt, Rüdiger; Kroemer, Alexander; Loss, Martin; Rümmele, Petra; Scherer, Marcus N.; Padberg, Winfried; Königsrainer, Alfred; Lang, Hauke; Obed, Aiman; Schlitt, Hans J.

doi:10.1097/sla.0b013e31824856f5

Cited by 1,138 publications

(1,073 citation statements)

References 58 publications

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“…When performing the ALPPS procedure 24 in patients with marginally resectable liver metastases, nearly all groups described high rates of biliary leakage and necrosis of segment IV 25.…”

Section: Discussionmentioning

confidence: 99%

Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Alghamdi

Viebahn

Justinger

et al. 2017

American Journal of Transplantation

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The risk of ischemia of segment IV after split liver resection is high. This anatomical study was done to identify the arterial blood supply and the intrahepatic distribution of liver segment IV. The anatomy of segment IV was studied in 29 livers from adult cadavers. To identify the arterial blood supply of segment IV, water and ink were injected into the various branches of the hepatic artery and the outflow through segment IV and discoloration of the liver parenchyma were observed. In 23 of the 29 livers (79.3%), the arterial perfusion of segment IV was separated by a line drawn from the left side of the inferior vena cava at the top of and lateral to the falciform ligament to the medial point of the gallbladder bed. The area lateral to this line was supplied mainly by the right hepatic artery, and the area medial to it was supplied mainly by the left hepatic artery. In addition to the classification system of Couinaud, we describe here a new division of liver segment IV based on arterial blood supply. These anatomical findings may be useful in defining the resection line for split liver to prevent necrosis of segment IV.

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“…When performing the ALPPS procedure 24 in patients with marginally resectable liver metastases, nearly all groups described high rates of biliary leakage and necrosis of segment IV 25.…”

Section: Discussionmentioning

confidence: 99%

Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Alghamdi

Viebahn

Justinger

et al. 2017

American Journal of Transplantation

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“…Associating Liver Partition and Portal vein ligation (PVL) for Staged hepatectomy (ALPPS) is an alternative technique for expansion of the FLR6. The ALPPS procedure combines selective PVL and parenchymal transection between the part of the liver to be removed and the FLR, as well as local resections of any tumours in the FLR during the first stage (step 1), followed by resection of the deportalized liver at the second stage (step 2).…”

Section: Introductionmentioning

confidence: 99%

Experimental evaluation of liver regeneration patterns and liver function following ALPPS

et al. 2017

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BackgroundThe underlying mechanism of liver regeneration after Associating Liver Partition and Portal vein ligation (PVL) for Staged hepatectomy (ALPPS) is still unclear. The aim of this study was to evaluate the relationship between future liver remnant (FLR) volume, liver regeneration characteristics and restoration of function in an experimental model of ALPPS.MethodsAn ALPPS model in rats was developed with selective PVL, parenchymal transection and partial hepatectomy (step 1), followed by resection of the liver (step 2). Three different ALPPS groups with FLR sizes of 30, 20 and 10 per cent of total liver volume were compared with sham‐operated controls and animals undergoing resection of left lateral lobe and 90 per cent PVL with respect to morbidity, mortality, liver regeneration and function.ResultsThree of 15 animals that had ALPPS with 10 per cent FLR (ALPPS10) died after step 1. Ascites developed in two of five rats that had ALPPS with 20 per cent FLR and in three of four animals in the ALPPS10 group after step 2. Although the relative increments in FLR size and growth rates were highest in the ALPPS groups, small FLR size was associated with a sustained increase in levels of serum aminotransferases and bilirubin, a lower albumin concentration, severe sinusoidal injury, increased expression of proliferation markers and increased activation of hepatic progenitor cells after step 2.ConclusionThere is discordance between FLR volume increase and functional restoration after the ALPPS procedure.

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“…Un trabajo publicado por Schnitzbauer 3 promete ser el próximo aporte a la cirugía hepatobiliar, realizando en un primer tiempo la ligadura de vena porta derecha asociado a una transección hepática in situ, y en un segundo tiempo completando la hepatectomía derecha 3 . De esta manera se ha comprobado una reducción en los tiempos de hipertrofia del remanente hepático futuro, y una mayor hipertrofia de este último, en comparación a métodos previos 6 .…”

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Asociación De La Partición Hepática Y Ligadura De La Vena Portal Para Hepatectomía Por Etapas, Un Nuevo Procedimiento en Cirugía Hepática

Núñez

et al. 2015

Rev Chil Cir

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associating liver partition and portal vein ligation for staged hepatectomy, a new hepatic procedure introduction: Hepatic resection is the standard treatment for the liver tumors and in most cases the only potentially curative option. The most feared complication, in the major hepatic resection, is the postoperative liver failure. A new technique has recently been published in the literature: Liver partition associated to a portal vein ligation for staged hepatectomy. This technique allows an accelerated hipertrophy of the remnant liver, facilitates greater resection surgery, reducing the risk of postoperative hepatic ischemia. The results reported in the literature are promising. We report the first case in Chile with its evolution to 2 years and a discussion about the topic.

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Right Portal Vein Ligation Combined With In Situ Splitting Induces Rapid Left Lateral Liver Lobe Hypertrophy Enabling 2-Staged Extended Right Hepatic Resection in Small-for-Size Settings

Abstract: Two-step hepatic resection performing surgical exploration, PVL, and ISS results in a marked and rapid hypertrophy of functional liver tissue and enables curative resection of marginally resectable liver tumors or metastases in patients that might otherwise be regarded as palliative.

Cited by 1,138 publications

References 58 publications

Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Arterial Blood Supply of Liver Segment IV and Its Possible Surgical Consequences

Experimental evaluation of liver regeneration patterns and liver function following ALPPS

Asociación De La Partición Hepática Y Ligadura De La Vena Portal Para Hepatectomía Por Etapas, Un Nuevo Procedimiento en Cirugía Hepática

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