A New Surgical Technique for Extended Right Hepatectomy: Tourniquet in the Umbilical Fissure and Right Portal Vein Occlusion (ALTPS). Clinical Case

Abstract

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 380ml (20% of the total volume) increasing 150% at 7 days (to 953ml, 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.