Transition from open to laparoscopic ALPPS for patients with very small FLR: the initial experience.
Laparoscopic ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) has previously been reported but has been the authors' default option since 2015 in patients with small future liver remnant.



A retrospective analysis of all consecutive patients undergoing ALPPS at a single referral center was performed using a prospective database from July 2011 to June 2016. Feasibility was studied by assessing conversions. The 90-day mortality and complications were analyzed using a Dindo-Clavien score and the comprehensive complication index. Operative time, blood loss, volumetric growth, and hospital stay were examined. The CUSUM analysis was performed.



ALPPS was performed in 30 patients, 10 of whom underwent a laparoscopic approach. There was no mortality and no complication grade ≥3A observed in laparoscopic ALPPS. In open ALPPS, 10 of 20 patients experienced complications grade ≥3A (p = 0.006) and one patient died. Liver failure was not observed after laparoscopic ALPPS, but two patients in the open ALPPS group developed complications that precluded the second stage. The total hospital stay was shorter in the laparoscopic ALPPS group.



Laparoscopic ALPPS is feasible as the default procedure for patients with very small FLR, and it is not inferior to the open approach. Surgeons experienced with complex laparoscopy should be encouraged to use a laparoscopic approach to ALPPS.
Department of Surgery, University of São Paulo, Brazil. Electronic address: dr@drmarcel.com.br.
Marcel A C
MA
Machado
Department of Surgery, University of São Paulo, Brazil.
Fábio F
FF
Makdissi
Department of Surgery, University of São Paulo, Brazil.
Rodrigo C
RC
Surjan
Department of Surgery, University of São Paulo, Brazil.
Tiago
T
Basseres
Rush University Medical Center, Chicago, IL, United States; Department of Surgery, Cantonal Hospital Winterthur and Institute of Physiology, University of Zurich, Switzerland.
Erik
E
Schadde
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001938:Brazil; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008026:Ligation; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D018579:Patient Selection; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome