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



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.


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).


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.


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


Colorectal Liver Metastasis Future Liver Remnant Middle Hepatic Vein Left Liver Left Portal Vein 
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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)


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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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