title: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks.
abstract: BACKGROUND
  Posthepatectomy liver failure is the most severe complication after major hepatectomies and it is associated with an insufficient future liver remnant (FLR). Associating liver partition and portal vein ligation (PVL) has recently been described as a revolutionary strategy to induce a rapid and large FLR volume increase. We aim to describe our surgical technique, patient management, and preliminary results with this new two-stage approach.
  
  
  METHODS
  During the first stage, liver partition and PVL of the diseased hemiliver are performed. The completion surgery is carried out after volumetric studies have demonstrated a sufficient FLR and provided the patient is in good condition. This is usually achieved after 7 days. In the second step, the patient undergoes a completion surgery with right hepatectomy, right trisectionectomy, or left trisectionectomy.
  
  
  RESULTS
  Fifteen patients with advanced liver tumors were treated. Nine patients were males and the mean age was 54 years old. The mean difference between the preoperative and postoperative FLR volume was 303 ml (p < 0.001), which represented a mean volume increase of 78.4 %. All resections were R0. Morbidity and mortality rates were 53 and 0 %, respectively. The average hospital stay was 19 days.
  
  
  CONCLUSIONS
  The presented technique was feasible and safe in the hands of experienced hepatobiliary surgeons, with satisfactory short-term results. It induces rapid liver hypertrophy and at the same time it offers the possibility of cure to patients previously declared unresectable.
authors.affiliation: General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Alvarez
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Sanchez Claria
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
mesh_terms: D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*