title: Staged liver resection for perihilar liver tumors using a tourniquet in the umbilical fissure and sequential portal vein embolization on the fourth postoperative day (a modified ALTPS).
abstract: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) achieves the hypertrophy of the future liver remnant in seven days. We achieved the same hypertrophy placing a tourniquet in the parenchimal transection line associating a right portal vein ligation (associating liver tourniquet and right portal vein ligation for staged hepatectomy-ALTPS). In perihiliar tumors a«non touch» technique should be performed. ALPPS y ALTPS do not comply with this technical aspect because a dissection of the hilum is carried out in both procedures during the portal dissection. To avoid this problem we devised a new method called sequential ALTPS. It consists of placing a tourniquet in the umbilical fissure without ligation of the right portal vein during the first stage. Subsequently, on the 4(th) postoperative day we perform a percutaneous right portal vein embolization. We present the first case of this new technique in which we have obtained a hypertrophy of 77% of the future liver remnant seven days after portal vein embolization. In the second stage a right trisectionectomy was performed with inferior vena cava resection with a goretex graft replacement.
authors.affiliation: Unidad de Cirugía Hepática, Departamento de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: rirocam@um.es.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles Campos
authors.affiliation: Unidad de Cirugía Hepática, Departamento de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Roberto
authors.initials: R
authors.lastname: Brusadin
authors.affiliation: Unidad de Cirugía Hepática, Departamento de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Asunción
authors.initials: A
authors.lastname: López Conesa
authors.affiliation: Unidad de Cirugía Hepática, Departamento de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla Paricio
mesh_terms: D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000601:surgery*; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011184:Postoperative Period; D013997:Time Factors; D014111:Tourniquets
keywords: ALPPS; ALTPS modificado; Colangiocarcinoma intrahepático; Intrahepatic cholangiocarcinoma; Liver Regeneration; Modified ALTPS; Regeneración hepática; Resecciones hepáticas en dos tiempos; Right trisectionectomy; Triseccionectomía derecha; Two-stage liver resections