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Annals of Surgical Oncology

, Volume 24, Issue 4, pp 1048–1049 | Cite as

Total Laparoscopic Reversal ALPPS

  • M. A. Machado
  • R. Surjan
  • T. Basseres
  • F. Makdissi
Hepatobiliary Tumors

Abstract

Background

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver.

Patient

A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment. The computed tomography (CT) scan showed a predominance of metastases in the left liver and in the right anterior section. The right posterior section had three metastases. The plan was to perform a laparoscopic reversal ALPPS (left portal vein ligation combined with in situ splitting in a two-stage left trisectionectomy).

Technique

Three metastases in the right posterior section were resected, followed by liver partition and left portal vein ligature. The CT scan showed a 70 % increase in the future liver remnant. The second stage constituted left trisectionectomy. At laparoscopy after division of adhesions, the left Glissonian pedicle was divided with an endostapler. A stapler also was used to transect the left and middle hepatic veins, and the specimen was removed through a suprapubic incision. The operative times were respectively 5 and 3 h, and the patient was discharged on days 4 and 5, respectively. No blood transfusion or intensive care unit stay was necessary. At this writing, the patient shows no evidence of the disease 18 months after the procedure.

Conclusions

Reversal laparoscopic ALPPS is feasible and safe. Laparoscopy is useful for decreasing blood loss and optimizing visualization during liver transection.

Keywords

Colorectal Liver Metastasis Future Liver Remnant Middle Hepatic Vein Left Liver Left Portal Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

10434_2016_5620_MOESM1_ESM.mp4 (151.3 mb)
This video shows detailed technical description of a total laparoscopic reversal ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy). This denomination is used when the future liver remnant is the right posterior section of the liver. Supplementary material 1 (MP4 154966 kb)

References

  1. 1.
    Schadde E, Ardiles V, Slankamenac K, et al. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg. 2014;38:1510–9.CrossRefPubMedGoogle Scholar
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    Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling two-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255:405–14.CrossRefPubMedGoogle Scholar
  3. 3.
    Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic ALPPS is feasible and may be worthwhile. Ann Surg. 2012;256:e13.CrossRefPubMedGoogle Scholar
  4. 4.
    Xiao L, Li JW, Zheng SG. Totally laparoscopic ALPPS in the treatment of cirrhotic hepatocellular carcinoma. Surg Endosc. 2015;29:2800–1.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • M. A. Machado
    • 1
  • R. Surjan
    • 1
  • T. Basseres
    • 1
  • F. Makdissi
    • 1
  1. 1.Department of SurgeryUniversity of São PauloSão PauloBrazil

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