Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 18, 2015; 7(23): 2492-2496
Published online Oct 18, 2015. doi: 10.4254/wjh.v7.i23.2492
Arterial ischemia in the deportalized liver following associating liver partition and portal vein ligation for staged hepatectomy
Srinivas Sanjeevi, Ernesto Sparrelid, Stefan Gilg, Eduard Jonas, Bengt Isaksson
Srinivas Sanjeevi, Department of Surgical Gastroenterology, Karolinska University Hospital, 14186 Stockholm, Sweden
Ernesto Sparrelid, Stefan Gilg, Eduard Jonas, Bengt Isaksson, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186 Stockholm, Sweden
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: This case report has been approved by the Karolinska University Hospital’s Hepatic Surgery Board.
Informed consent statement: The patient described in the case report provided verbal consent prior to submission for publication.
Conflict-of-interest statement: The authors have no conflicts of interest to declare. This work did not receive any support or funding.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bengt Isaksson, MD, PhD, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Gastrocentrum, K53, 14186 Stockholm, Sweden. bengt.isaksson@karolinska.se
Telephone: +46-07-36994477 Fax: +46-08-58582340
Received: June 10, 2015
Peer-review started: June 12, 2015
First decision: July 25, 2015
Revised: August 3, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: October 18, 2015
Abstract

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel 2-stage technique intended to induce rapid growth of the future liver remnant (FLR). Initial reports of a 12% mortality rate have sparked debate regarding the safety of the procedure. A 64 years old male was planned for a right-sided hemi-hepatectomy due to colorectal cancer liver metastases. Intra-operatively it was decided to convert to an ALPPS due to unexpectedly small segments 2-4. Post-operative serum laboratory tests indicated an acute liver failure and radiological imaging showed no sign of arterial blood flow to the right hemi-liver. A computed tomography examination on post-operative day 3 revealed that the FLR had increased from 290 to 690 mL in 3 d (138% growth). In the following days serum values gradually improved and stage 2 was carried out on post-operative day 7. The rest of the hospital stay was uneventful and the patient made a full recovery. ALPPS is a fascinating advancement in liver surgery. Despite severe post-operative complications, in properly selected cases it provides successful outcomes that other modalities of treatment cannot offer.

Keywords: Associating liver partition and portal vein ligation for staged hepatectomy, Liver surgery, Acute liver failure, Future liver remnant

Core tip: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel 2-stage technique intended to induce rapid growth of the future liver remnant. Initial reports of a 12% mortality rate have sparked debate regarding the safety of the procedure. We here present a complication following ALPPS that to our knowledge has never been described before. Yet proper patient selection resulted in a full recovery following a potentially life threatening liver failure.