Arterial ischemia in the deportalized liver following associating liver partition and portal vein ligation for staged hepatectomy.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel 2-stage technique intended to induce rapid growth of the future liver remnant (FLR). Initial reports of a 12% mortality rate have sparked debate regarding the safety of the procedure. A 64 years old male was planned for a right-sided hemi-hepatectomy due to colorectal cancer liver metastases. Intra-operatively it was decided to convert to an ALPPS due to unexpectedly small segments 2-4. Post-operative serum laboratory tests indicated an acute liver failure and radiological imaging showed no sign of arterial blood flow to the right hemi-liver. A computed tomography examination on post-operative day 3 revealed that the FLR had increased from 290 to 690 mL in 3 d (138% growth). In the following days serum values gradually improved and stage 2 was carried out on post-operative day 7. The rest of the hospital stay was uneventful and the patient made a full recovery. ALPPS is a fascinating advancement in liver surgery. Despite severe post-operative complications, in properly selected cases it provides successful outcomes that other modalities of treatment cannot offer.
Srinivas Sanjeevi, Department of Surgical Gastroenterology, Karolinska University Hospital, 14186 Stockholm, Sweden.
Srinivas
S
Sanjeevi
Srinivas Sanjeevi, Department of Surgical Gastroenterology, Karolinska University Hospital, 14186 Stockholm, Sweden.
Ernesto
E
Sparrelid
Srinivas Sanjeevi, Department of Surgical Gastroenterology, Karolinska University Hospital, 14186 Stockholm, Sweden.
Stefan
S
Gilg
Srinivas Sanjeevi, Department of Surgical Gastroenterology, Karolinska University Hospital, 14186 Stockholm, Sweden.
Eduard
E
Jonas
Srinivas Sanjeevi, Department of Surgical Gastroenterology, Karolinska University Hospital, 14186 Stockholm, Sweden.
Bengt
B
Isaksson
Acute liver failure; Associating liver partition and portal vein ligation for staged hepatectomy; Future liver remnant; Liver surgery