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ALPPS procedure

S E Voskanyan, E S Chuchuyev, A I Artemiyev, D A Zabezhinsky, A N Bashkov, A S Zhurbin, V S Rudakov, S V Cholakyan
AIM: To determine ALPPS advisability in small future remnant liver. MATERIAL AND METHODS: 22 ALPPS procedures were performed at the Center for Surgery and Transplantology for the period from 2011 to 2016. Indications were both tumoral and non-tumoral unresectable liver diseases. Postoperative complications were classified according to Clavien-Dindo, ISGLS. RESULTS: According to CT-volumetry future remnant liver before the 1st stage of ALPPS was from 17 to 25%, before the 2nd stage - from 28 to 49%...
2018: Khirurgiia
Niklas Pakkasjärvi, Seppo Taskinen
INTRODUCTION: Sphincter insufficiency is mostly associated with neurogenic and some structural abnormalities in the pediatric population. As a mini-invasive treatment, urethral bulking agents have been used to treat this problem. OBJECTIVE: The aim was to evaluate if technical success, defined as intraoperative increase in abdominal leak point pressure (ALPP), predicts the outcome of the treatment of sphincter insufficiency with urethral bulking agent. STUDY DESIGN: We reviewed all children treated first time with dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux) for urethral sphincter insufficiency and who intraoperatively had ALPPs measured during 2004-2014...
January 31, 2018: Journal of Pediatric Urology
Sami Akbulut, Egemen Cicek, Mehmet Kolu, Tevfik Tolga Sahin, Sezai Yilmaz
Alveolar echinococcosis (AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins (R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis...
January 27, 2018: World Journal of Gastrointestinal Surgery
Zhixia Rong, Qian Lu, Jun Yan
RATIONALE: Adequate future liver remnant (FLR) volume is often a concern for patients with hepatocellular carcinoma (HCC). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure can rapidly lead to impressive growth of FLR. We describe the technique of an entirely laparoscopic radiofrequency-assisted liver partition with portal vein ligation for staged hepatectomy (RALPP) in a cirrhotic patient with HCC. PATIENT CONCERNS: A 33 year-old female cirrhotic patient with HCC in the right liver was indicated for RALPP as the predicted future liver remnant (FLR) was 21%...
December 2017: Medicine (Baltimore)
Alessandro Lunardi, Rosa Cervelli, Duccio Volterrani, Saverio Vitali, Carlo Lombardo, Giulia Lorenzoni, Laura Crocetti, Irene Bargellini, Daniela Campani, Luca Emanuele Pollina, Roberto Cioni, Davide Caramella, Ugo Boggi
PURPOSE: To assess the feasibility of radiological stage-1 ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, by combining portal vein embolization (PVE) with percutaneous intrahepatic split by ablation (PISA). MATERIALS AND METHODS: Three patients (mean age 65.0 ± 7.3 years) underwent PVE and PISA. PISA was performed 21 days after PVE by microwave ablation to create a continuous intrahepatic cutting plane. Abdominal CT examinations were performed before and after PVE and PISA...
January 22, 2018: Cardiovascular and Interventional Radiology
Gregor A Stavrou, Marcello Donati, Mohammad H Fard-Aghaie, Martin Zeile, Tessa M Huber, Axel Stang, Karl J Oldhafer
Background: ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced only 10 years ago and has gained wide acceptance as a variation of staged procedures in liver surgery. It has been criticized for its high morbidity and mortality, which all centers reported in their initial series. Methods: After a world expert meeting in Hamburg in 2015 where all experts in the field met to discuss this method, caveats were extracted and formulated...
December 2017: Visceral Medicine
Andreas A Schnitzbauer
Background: Portal vein embolization (PVE) followed by resection and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are tools to enable liver resections in small-for-size settings. Methods: A systematic review of the literature and comparison of pitfalls between PVE and resection and after ALPPS stage 1 were performed. Results: Evidence levels were as low as 4 for both procedures. 20 publications were identified with reports on post-PVE or post-ALPPS stage 1 pitfalls...
December 2017: Visceral Medicine
C Hackl, S M Brunner, K M Schmidt, H J Schlitt
BACKGROUND: Extensive, bilobular and multifocal colorectal liver metastases (CLM) or metastases that are critically situated require an experienced surgeon and advanced surgical techniques to enable curative resection. OBJECTIVE: This article describes the toolbox of hepato-oncologic surgery including functional augmentation of liver segments by portal vein embolization/ligation, combinations of ablation and resection, two-stage resections and in situ split liver resection, also known as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)...
March 2018: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
K H Lin, H T Hsu, T H Teng, P Y Lin, C J Ko, C E Hsieh, Y L Chen
BACKGROUND: Liver regeneration is dependent on the proliferation of hepatocytes. Hepatic progenitor cells are intra-hepatic precursor cells capable of differentiating into hepatocytes or biliary cells. Although liver progenitor cell proliferation during the regenerative process has been observed in animal models of severe liver injury, it has never been observed in vivo in humans because it is unethical to take multiple biopsy specimens for the purpose of studying the proliferation of liver progenitor cells and the roles they play in liver regeneration...
December 2017: Malaysian Journal of Pathology
Srinivas Sanjeevi, Ernesto Sparrelid, Stefan Gilg, Eduard Jonas, Bengt Isaksson
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two-stage procedure most frequently applied in the setting of an extended right-sided hemi-hepatectomy. Initial reports of high mortality have sparked debate regarding the safety and efficacy of the procedure. We describe a higher incidence of early post-operative bile duct strictures after ALPPS, a complication rarely seen after conventional liver resection. METHODS: An institutional review was conducted to assess the incidence of post-operative biliary strictures following conventional right-sided or extended right-sided hemi-hepatectomy and ALPPS...
December 14, 2017: ANZ Journal of Surgery
Yutaro Kikuchi, Yukihiko Hiroshima, Kenichi Matsuo, Takashi Murakami, Daisuke Kawaguchi, Kohei Kasahara, Kuniya Tanaka
BACKGROUND: The impact of associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) on tumor growth activity was investigated. METHODS: A BALB/c mouse model (male, 8-10 weeks old) of liver metastasis labeled by red fluorescent protein was established. Changes in future liver remnant (FLR) volumes, tumor growth activity, and levels of cytokines and growth factors in liver tissues during the treatment period were compared among the models involving ALPPS, portal vein ligation (PVL), or sham operation...
January 2018: European Journal of Surgical Oncology
Ibrahim Al Hasan, Mauro Enrique Tun-Abraham, Kerollos N Wanis, Carlos Garcia-Ochoa, Mark A Levstik, Bandar Al-Judaibi, Roberto Hernandez-Alejandro
BACKGROUND: Early reports of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) outcomes have been suboptimal. The literature has confirmed that learning curves influence surgical outcomes. We have 54 months of continuous experience performing ALPPS with strict selection criteria. This study aimed to evaluate the impact of the learning curve on ALPPS outcomes. METHODS: We retrospectively compared patients who underwent ALPPS between April 2012 and March 2016...
December 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Henrik Petrowsky, Pierre-Alain Clavien
No abstract text is available yet for this article.
December 2017: Annals of Surgery
Giuseppe Maria Ettorre, Nicola Guglielmo, Roberto Luca Meniconi, Giovanni Battista Levi Sandri, Marco Colasanti, Giovanni Vennarecci
No abstract text is available yet for this article.
December 2017: Annals of Surgery
Young Il Choi, Hyung Hwan Moon, Dong Hoon Shin
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been introduced as a new surgical technique to increase future liver remnant in patients with marginal liver volume contemplating major liver resection. We herein present two cases. Case 1: a 68-year-old male patient with colorectal liver metastasis was referred to our department. The future liver remnant (FLR) was 22%. We performed first-stage ALPPS and colorectal surgery concurrently and second stage operation was performed 8 days later...
August 2017: Annals of Hepato-Biliary-Pancreatic Surgery
Henrique Alexandrino, Anabela Rolo, João S Teodoro, Henrique Donato, Ricardo Martins, Marco Serôdio, Mónica Martins, José G Tralhão, Filipe Caseiro Alves, Carlos Palmeira, Francisco Castro E Sousa
BACKGROUND: The Associating Liver Partition and Portal Ligation for Staged Hepatectomy (ALPPS) depends on a significant inter-stages kinetic growth rate (KGR). Liver regeneration is highly energy-dependent. The metabolic adaptations in ALPPS are unknown. AIMS: i) Assess bioenergetics in both stages of ALPPS (T1 and T2) and compare them with control patients undergoing minor (miHp) and major hepatectomy (MaHp), respectively; ii) Correlate findings in ALPPS with volumetric data; iii) Investigate expression of genes involved in liver regeneration and energy metabolism...
December 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Marcelo Enne, Erik Schadde, Bergthór Björnsson, Roberto Hernandez Alejandro, Klaus Steinbruck, Eduardo Viana, Ricardo Robles Campos, Massimo Malago, Pierre-Alain Clavien, Eduardo De Santibanes, Brice Gayet
BACKGROUND: A minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a "Salvage Procedure" for PVO failure. The aim of this study was to report the short term outcomes of ALPPS following PVO failure. METHODS: A retrospective analysis of patients enrolled within the international ALPPS Registry between October 2012 and November 2015 (NCT01924741) was performed...
December 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Luca Aldrighetti, Francesca Ratti, Umberto Cillo, Alessandro Ferrero, Giuseppe Maria Ettorre, Alfredo Guglielmi, Felice Giuliante, Fulvio Calise
The Italian Group of MILS (I Go MILS) prospective registry was established in 2014 with the goals to create a hub for data and projects on a national basis and to promote the diffusion and implementation of MILS programs on a national scale. The primary endpoint of the present study is to give a snapshot of the real diffusion and outcomes of MILS in Italy, while analyzing the role of the registry in the implementation of MILS programs nationwide. The I Go MILS Registry is a prospective and intention-to-treat registry opened to any Italian center performing MILS, without restriction criteria based on number of procedures...
September 2017: Updates in Surgery
Martin Stockmann, Jan Bednarsch, Maciej Malinowski, Elisabeth Blüthner, Johann Pratschke, Daniel Seehofer, Maximilian Jara
BACKGROUND: Since perioperative morbidity and mortality in ALPPS are extraordinarily high, a deeper understanding of actual liver function during the procedure is essential to make the approach safer. METHODS: Data from 17 patients who underwent ALLPS were analyzed regarding their course of liver function capacity assessed with the LiMAx test and compared to an equal-sized matched cohort of patients that underwent PVE. RESULTS: A comparison of LiMAx prior to and following ALPPS Step I (330 [258-385] vs...
November 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Erik Schadde, Martin Hertl, Stefan Breitenstein, Beatrice Beck-Schimmer, Martin Schläpfer
Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver metastases, the amount of liver tissue left behind after liver resection has become the main limiting factor of resectability of large or multiple liver tumors. A minimal amount of functional tissue is required to avoid the severe complication of post-hepatectomy liver failure, which has high morbidity and mortality. Inducing liver growth of the prospective remnant prior to resection has become more established in liver surgery, either in the form of portal vein embolization by interventional radiologists or in the form of portal vein ligation several weeks prior to resection...
August 14, 2017: Journal of Visualized Experiments: JoVE
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