A new surgical technique for extended right hepatectomy: tourniquet in the umbilical fissure and right portal vein occlusion (ALTPS). Clinical case

• Published in: Cirugia Española Vol. 91; no. 10; p. 633
• Main Authors: Robles Campos, Ricardo, Parrilla Paricio, Pascual, López Conesa, Asunción, Brusadín, Roberto, López López, Víctor, Jimeno Griñó, Pilar, Fuster Quiñonero, Matilde, García López, José Antonio, de la Peña Moral, Jesús
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-12-2013
• Subjects: Hepatectomy - methods; Humans; Ligation; Liver Neoplasms - surgery; Male; Middle Aged; Portal Vein - surgery; Tourniquets; Two-stage liver resections; Right trisectionectomy; Resección de vena cava inferior; Trisectorectomía derecha; Liver tumors; Recidiva de hipernefroma; Recurrent hypernephroma; Tumores hepáticos; Inferior vena cava resection; Resecciones hepáticas en 2 tiempos
• ISSN: 1578-147X
• DOI: 10.1016/j.ciresp.2013.09.004

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), in 2-stage liver resections, achieves hypertrophy of the functional liver remnant (FLR) in 7 days, and the objective of this technique is the occlusion of the intrahepatic collaterals. In March 2012 we published a new surgical technique associating the insertion of a tourniquet in Cantlie' line and right portal vein ligation (ALTPS: Associating liver tourniquet and right portal vein occlusion for staged hepatectomy). In this paper we present this ALTPS technique placing the tourniquet in the umbilical fissure to obtain hypertrophy of segments II-III. It was performed in a 51 year-old patient with a recurrent right renal hypernephroma which involved all the anatomic right lobe and inferior vena cava. Preoperative FLR was 380 ml (20% of the total volume) increasing 150% at 7 days (to 953 ml, 31% of the total). In the second step, we performed a right trisectionectomy and retrohepatic inferior vena cava resection, replacing it by a 2 cm-ring goretex graft.