Modification of ALPPS to avoid ischemia and congestion after stage 1: a case report
Abstract Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been advocated for treating advanced liver tumors, but the devascularized ischemic area resulting from liver parenchymal division can become a nidus for sepsis. We present a patient who underw...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-07-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-022-01490-x |
| _version_ | 1828785590941777920 |
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| author | Mai Ishihara Yuki Takahashi Kenichi Matsuo Akihiro Nakamura Shinji Togo Kuniya Tanaka |
| author_facet | Mai Ishihara Yuki Takahashi Kenichi Matsuo Akihiro Nakamura Shinji Togo Kuniya Tanaka |
| author_sort | Mai Ishihara |
| collection | DOAJ |
| description | Abstract Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been advocated for treating advanced liver tumors, but the devascularized ischemic area resulting from liver parenchymal division can become a nidus for sepsis. We present a patient who underwent ALPPS modified to avoid ischemia and congestion after liver partitioning during stage 1. Case presentation ALPPS was carried out for a patient with multiple bilobar liver metastases from rectosigmoid colon cancer. The 2-stage treatment included 3 partial resections within the left lateral section and parenchymal division at the umbilical fissure with right portal vein ligation as stage 1, followed by right trisectionectomy as stage 2. During parenchymal division at the umbilical fissure, Segment 4 portal pedicles and the middle hepatic vein had to be resected at their roots. To safely accomplish this, combined resection of Segment 4 and the drainage area of the middle hepatic vein was performed after parenchymal partition, aiming to avoid ischemia and congestion within the remnant liver. Successful stage 2 hepatectomy followed later. No ischemia or congestion occurred during stage 1 or 2. Conclusions During ALPPS, ischemia and congestion after stage 1 must be avoided to reduce morbidity and mortality. The modification described here should reduce likelihood of severe postoperative complications. |
| first_indexed | 2024-12-11T23:53:54Z |
| format | Article |
| id | doaj.art-d8cdeed197f143f5bc88565786837431 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-11T23:53:54Z |
| publishDate | 2022-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-d8cdeed197f143f5bc885657868374312022-12-22T00:45:24ZengSpringerOpenSurgical Case Reports2198-77932022-07-01811710.1186/s40792-022-01490-xModification of ALPPS to avoid ischemia and congestion after stage 1: a case reportMai Ishihara0Yuki Takahashi1Kenichi Matsuo2Akihiro Nakamura3Shinji Togo4Kuniya Tanaka5Department of General and Gastroenterological Surgery, Showa University Fujigaoka HospitalDepartment of General and Gastroenterological Surgery, Showa University Fujigaoka HospitalDepartment of General and Gastroenterological Surgery, Showa University Fujigaoka HospitalDepartment of General and Gastroenterological Surgery, Showa University Fujigaoka HospitalIshikawacho Internal Medical ClinicDepartment of General and Gastroenterological Surgery, Showa University Fujigaoka HospitalAbstract Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been advocated for treating advanced liver tumors, but the devascularized ischemic area resulting from liver parenchymal division can become a nidus for sepsis. We present a patient who underwent ALPPS modified to avoid ischemia and congestion after liver partitioning during stage 1. Case presentation ALPPS was carried out for a patient with multiple bilobar liver metastases from rectosigmoid colon cancer. The 2-stage treatment included 3 partial resections within the left lateral section and parenchymal division at the umbilical fissure with right portal vein ligation as stage 1, followed by right trisectionectomy as stage 2. During parenchymal division at the umbilical fissure, Segment 4 portal pedicles and the middle hepatic vein had to be resected at their roots. To safely accomplish this, combined resection of Segment 4 and the drainage area of the middle hepatic vein was performed after parenchymal partition, aiming to avoid ischemia and congestion within the remnant liver. Successful stage 2 hepatectomy followed later. No ischemia or congestion occurred during stage 1 or 2. Conclusions During ALPPS, ischemia and congestion after stage 1 must be avoided to reduce morbidity and mortality. The modification described here should reduce likelihood of severe postoperative complications.https://doi.org/10.1186/s40792-022-01490-xHepatectomyALPPSModified techniqueIschemiaCongestion |
| spellingShingle | Mai Ishihara Yuki Takahashi Kenichi Matsuo Akihiro Nakamura Shinji Togo Kuniya Tanaka Modification of ALPPS to avoid ischemia and congestion after stage 1: a case report Surgical Case Reports Hepatectomy ALPPS Modified technique Ischemia Congestion |
| title | Modification of ALPPS to avoid ischemia and congestion after stage 1: a case report |
| title_full | Modification of ALPPS to avoid ischemia and congestion after stage 1: a case report |
| title_fullStr | Modification of ALPPS to avoid ischemia and congestion after stage 1: a case report |
| title_full_unstemmed | Modification of ALPPS to avoid ischemia and congestion after stage 1: a case report |
| title_short | Modification of ALPPS to avoid ischemia and congestion after stage 1: a case report |
| title_sort | modification of alpps to avoid ischemia and congestion after stage 1 a case report |
| topic | Hepatectomy ALPPS Modified technique Ischemia Congestion |
| url | https://doi.org/10.1186/s40792-022-01490-x |
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