title: Variation on a Theme: Alternative to Plastic Bag in ALPPS Procedures: Feasibility and Clinical Safety of COVA+™ Membrane in ALPPS Procedures.
abstract: BACKGROUND
  Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) got wide success among hepatic surgeons as an efficient way to shorten to 7 days from the 4 weeks interval of classic 2-staged hepatectomy. The main disadvantage of ALPPS is the onset of inflammatory adhesions, particularly on the hepatic pedicle region, previously dissected. The aim of the study is the evaluation of a resorbable collagen membrane (CM) indicated in the prevention of postoperative adhesions as an alternative to the use of a plastic bag (PB) during ALPPS procedure.
  
  
  METHODS
  All patients undergoing ALPPS procedure in our department were prospectively included in a database. At the end of the first surgery, at least one resorbable CM (COVA+™, Biom'Up, France) was placed instead of a PB. Intraoperative adhesions during the second step and clinical short-term safety were assessed.
  
  
  RESULTS
  Ten patients with a mean age of 57.5 years underwent a 2-staged hepatectomy through ALPPS approach. At the second stage, 90 % of the patients experienced either grade-0 (no adhesion) or grade-I adhesions (mild adhesions easily divided). None of the reported complications were related to the use of the CM.
  
  
  CONCLUSIONS
  To our knowledge, this is the first clinical study evaluating the use of an anti-adhesion resorbable CM as a safe and efficient alternative to PB in ALPPS procedures.
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. raffaele.brustia@gmail.com.|Université Pierre et Marie Curie, Paris, France. raffaele.brustia@gmail.com.
authors: Raffaele
authors: R
authors: Brustia
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.|Université Pierre et Marie Curie, Paris, France.
authors: Olivier
authors: O
authors: Scatton
authors: Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France. olivier.soubrane@aphp.fr.|Université Diderot, Paris, France. olivier.soubrane@aphp.fr.
authors: Olivier
authors: O
authors: Soubrane
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000009:adverse effects / Q000627:therapeutic use*; D003094:Collagen / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010969:Plastics / Q000009:adverse effects; D011169:Portal Vein / Q000601:surgery; D000267:Tissue Adhesions / Q000517:prevention & control*
chemical_list: D001672:Biocompatible Materials; D008567:Membranes, Artificial; D010969:Plastics; D003094:Collagen