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Ferenc Jakab
Numerous outstanding summarizing publications on the milestones of the rapid development of liver surgery in the twentieth century came to light around the year 2000, therefore in this summary only the newest principles and novelties of liver surgery after the second millennium are presented. Among the new principles, the newest indications, the bloodless surgery and the vascular exclusion of the liver, the "associating liver partition and portal vein occlusion for staged hepatectomy" (ALPPS) - as presently the fastest and most successful method for liver regeneration, and the "downsizing of tumors" treatment for the interest of resection of unresectable tumours are analyzed and evaluated...
March 2018: Orvosi Hetilap
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
Adeel S Khan, Sandra Garcia-Aroz, Mohammad A Ansari, Syed M Atiq, Michael Senter-Zapata, Kathryn Fowler, M B Doyle, W C Chapman
Post hepatectomy liver failure (PHLF) remains a significant cause of morbidity and mortality after major liver resection. Although the etiology of PHLF is multifactorial, an inadequate functional liver remnant (FLR) is felt to be the most important modifiable predictor of PHLF. Pre-operative evaluation of FLR function and volume is of paramount importance before proceeding with any major liver resection. Patients with inadequate or borderline FLR volume must be considered for volume optimization strategies such as portal vein embolization (PVE), two stage hepatectomy with portal vein ligation (PVL), Yttrium-90 radioembolization, and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)...
February 6, 2018: International Journal of Surgery
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)
Daryl Kai Ann Chia, Zachery Yeo, Stanley Eu Kuang Loh, Shridhar Ganpathi Iyer, Krishnakumar Madhavan, Alfred Wei Chieh Kow
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been widely described for colorectal liver metastases with insufficient future liver remnant (FLR). However, its role in hepatocellular carcinoma (HCC) remains poorly defined and not widely accepted. METHODS: A retrospective comparison of clinical data, liver volumetry, histological characteristics, and surgical outcomes between nine HCC and four non-HCC patients who underwent ALPPS was performed...
January 29, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
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
F Rassam, E Roos, K P van Lienden, J E van Hooft, H J Klümpen, G van Tienhoven, R J Bennink, M R Engelbrecht, A Schoorlemmer, U H W Beuers, J Verheij, M G Besselink, O R Busch, T M van Gulik
AIM: Perihilar cholangiocarcinoma (PHC) is a challenging disease and requires aggressive surgical treatment in order to achieve curation. The assessment and work-up of patients with presumed PHC is multidisciplinary, complex and requires extensive experience. The aim of this paper is to review current aspects of diagnosis, preoperative work-up and extended resection in patients with PHC from the perspective of our own institutional experience with this complex tumor. METHODS: We provided a review of applied modalities in the diagnosis and work-up of PHC according to current literature...
January 19, 2018: Langenbeck's Archives of Surgery
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
Danby Kang, Erik Schadde
Background: ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced with the promise to reduce posthepatectomy liver failure (PHLF) in extended hepatectomies but has higher morbidity and mortality rates compared to conventional methods of volume enhancement. There are few studies of the incidence of PHLF after ALPPS and little information on how to avoid PHLF by functional testing. It remains unclear what causes the compromise in liver function despite rapid volume gain and if any of the modifications proposed reduce the incidence of PHLF...
December 2017: Visceral Medicine
Hans J Schlitt, Christina Hackl, Sven Arke Lang
Background: Liver tumors that are extensive, multifocal, or critically located frequently require advanced techniques of liver resection including '!' - enabling liver resection in certain situations. Methods: The development of the technique in the first and the subsequent 8 patients in the index center, and also the method's spread throughout Germany and the world were reviewed. Results: In 2007, in the first patient, the new technique was developed intraoperatively by necessity...
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
C Maulat, B Suc, F Muscari
No abstract text is available yet for this article.
January 3, 2018: Journal of Visceral Surgery
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
Zheng Zhou, Mingxing Xu, Nan Lin, Chuzhi Pan, Boxuan Zhou, Yuesi Zhong, Ruiyun Xu
BACKGROUND: It is generally accepted that an insufficient future liver remnant is a major limitation of large-scale hepatectomy for patients with primary hepatocellular carcinoma. Conventional two-stage hepatectomy (TSH) is commonly considered to accelerate future liver regeneration despite its low regeneration rate. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which is characterized by a rapid regeneration, has brought new opportunities. METHODS: Relevant studies were identified by searching the selected databases up to September 2017...
December 19, 2017: World Journal of Surgical Oncology
Patryk Kambakamba, Michael Linecker, Marcel Schneider, Cäcilia S Reiner, Thi Dan Linh Nguyen-Kim, Perparim Limani, Ivan Romic, Joan Figueras, Henrik Petrowsky, Pierre-Alain Clavien, Mickaël Lesurtel
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy induces an unprecedented liver hypertrophy and enables resection of otherwise unresectable liver tumors. The effect of associating liver partition and portal vein ligation for staged hepatectomy on tumor proliferation, however, remains a concern. This study investigated the impact of associating liver partition and portal vein ligation for staged hepatectomy on growth of colorectal metastases in mice and in humans...
December 13, 2017: Surgery
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
P P Li, Z H Wang, G Huang, Z P Huang, Y Li, J S Ni, H Liu, C H Fang, W P Zhou
Objective: To discuss the application of three dimentional(3D)visualization technologies in treatment plan of hepatic malignant tumor. Methods: The clinical data of 300 patients with liver malignant tumor who received treatment from January 2016 to January 2017 in the Third Department of Hepatic Surgery of Eastern Hepatobiliary Surgery Hospital was retrospectively analyzed in this study, including 221 male and 79 female patients aged from 7 to 76 years with median age of 54 years. The median height was 168 cm (115-183 cm), the median weight was 65 kg (20-105 kg) and the median tumor volume was 142 ml (23-2 493 ml)...
December 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
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