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ALPPS Two-stage Hepatectomy of the Liver

Two-stage hepatectomy with portal vein ligation and in-situ liver split.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is ALPPS Two-stage Hepatectomy of the Liver?

ALPPS is a two-stage hepatectomy strategy used in patients with insufficient future liver remnant volume, in whom standard resection or portal vein embolisation alone is inadequate. In the first stage portal vein ligation and in-situ parenchymal split are performed; the second stage is completed in 7-14 days after rapid hypertrophy.

Compared with traditional portal vein embolisation, hypertrophy of 60-100% develops within 7 days, allowing the second stage to be performed earlier and reducing the risk of progression in patients with high tumour burden.

It is associated with high morbidity and mortality and is reserved for selected patients (colorectal liver metastases, hepatocellular carcinoma, perihilar cholangiocarcinoma) at high-volume centres.

Symptoms

Postoperative liver failure
Bile leak
Intra-abdominal collection or abscess
Portal vein thrombosis
Sepsis
Bleeding
Pulmonary complications

Risk Factors

Insufficient future liver remnant volume
Bilobar colorectal liver metastases
Locally advanced hepatocellular carcinoma
Perihilar cholangiocarcinoma
Failed portal vein embolisation
Underlying chronic liver disease
Older age and severe comorbidity

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe abdominal pain or jaundice between stages
  • Persistent fever and signs of infection
  • Bile leak or persistent drain output
  • Findings of postoperative liver failure

Treatment Methods

01
Patient selection through multidisciplinary council
02
Right portal vein ligation in the first stage
03
In-situ parenchymal transection
04
Volumetric assessment by 3D imaging
05
Definitive hepatectomy in the second stage 7-14 days later
06
Intensive perioperative monitoring
07
Selection of high-volume centres for ALPPS

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.