Modified ALPPS Procedures Avoiding Division of Portal Pedicles

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Liver regeneration

Background:

• Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is used for advanced liver tumors.
• Sepsis from ischemic areas post-parenchymal division is a major cause of mortality in ALPPS.

Purpose of the Study:

• To describe a modified ALPPS procedure that preserves portal pedicles during parenchymal division.
• To reduce necrosis and improve safety in ALPPS.

Main Methods:

• The modified technique involves sparing portal pedicles at the transection plane to maintain blood supply.
• Specific pedicle preservation strategies are detailed for different hepatectomy extensions.

Main Results:

• The procedure was performed in 5 patients with 0% morbidity in the first stage and 80% in the second stage, with no mortality.
• Mean future liver remnant hypertrophy was 1.638 ± 0.384 per week after the first stage.

Conclusions:

• This modified ALPPS technique stimulates rapid liver remnant hypertrophy.
• Preserving portal pedicles may enhance the safety of ALPPS for liver tumor treatment.