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Comparative Study
. 2021 Jan 1;273(1):e22-e24.
doi: 10.1097/SLA.0000000000004244.

A New Surgical Technique Variant of Partial ALPPS (Tourniquet Partial-ALPPS)

Ricardo Robles-Campos  1 , Roberto Brusadín  1 , Víctor López-López  1 , Asunción López-Conesa  1 , Álvaro Navarro-Barrios  1 , Paula Gómez-Valles  1 , Albert Caballero-Illanes  2 , Valentín Cayuela-Fuentes  1 , Pascual Parrilla-Paricio  1
Affiliations
Comparative Study

A New Surgical Technique Variant of Partial ALPPS (Tourniquet Partial-ALPPS)

Ricardo Robles-Campos et al. Ann Surg. .

Abstract

Objective: We present a new variant of partial-ALPPS (p-ALPPS) "Tourniquet partial-ALPPS (Tp-ALPPS)", with the aim of reducing aggressiveness during stage 1.

Summary background data: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) results in liver regeneration in only 9 days. Due to its high initial morbidity and mortality, less aggressive variants were designed.

Methods: A new surgical variant of ALPPS was designed consisting in introducing a Kelly forceps from the base of the liver, crossing the liver parenchyma through an avascular area. A 3-mm Vicryl (V152; Ethicon, Somerville, New Jersey, USA) tape is passed, and the tourniquet is then knotted. Six patients operated on by this new Tp-ALPPS surgical technique were compared to 6 patients operated on by Tourniquet ALPPS (T-ALPPS).

Results: There were no differences in volume increase at 10 days. During stage 1, blood losses and transfusion rates tended to be lower in the Tp-ALPPS group, without statistical differences. Surgical time was shorter in the Tp-ALPPS group than in T-ALPPS (90 min versus 135 min) (p < 0.023). In stage 2, blood losses and transfusion were similar in both groups, but surgical time tended to be higher in the Tp-ALPPS group, which could be related to the surgical technique performed. There were no differences in morbidity and mortality.

Conclusions: Tp-ALPPS achieved a similar increase in volume as T-ALPPS but with a shorter stage 1 surgical and similar morbidity and mortality.

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Conflict of interest statement

The authors have nothing to disclose and declare no conflicts of interest.

References

    1. Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2- staged extended right hepatic resection in small-for-size settings. Ann Surg 2012; 255:405–414.
    1. Santibañes E, Clavien PA. Playing play-doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg 2012; 255:415–417.
    1. Robles R, Parrilla P, Lopez-Conesa A, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg 2014; 101:1129–1134. discussion 1134.
    1. Petrowsky H, Györi G, de Oliveira M, et al. Is partial-ALPPS safer than ALPPS? A single-center experience. Ann Surg 2015; 261:e90–e92.
    1. de Santibañes E, Alvarez FA, Ardiles V, et al. Inverting the ALPPS paradigm by minimizing first stage impact: The Mini-ALPPS technique. Langenbecks Arch Surg 2016; 401:557–563.

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