Portal Vein Ligation

Abstract

Portal vein ligation (PVL) is a standard procedure for achieving resectability in patients with an inadequate future remnant liver (FRL) prior to planning subsequent major hepatectomy. Its role in inducing FRL hypertrophy prior to major liver resection is clear [1]. Actually, PVL is the first step in a two-stage hepatectomy for treating initially unresectable liver metastases [1]. As reported in the literature, this procedure can be achieved safely without causing mortality [2]. Capussotti et al. showed how PVL is as effective as PV embolization in inducing hypertrophy of the remnant liver volume [2]. The possibility of using a laparoscopic approach seems to be favorable, even for achieving lower patient morbidity rates, particularly in the case of synchronous colorectal metastasis, avoiding the need to perform a further procedure (laparotomy/portal embolisation) [3,4]. Finally, in a planned two-stage hepatectomy, laparoscopic PVL (LPVL) greatly reduces the presence of adhesions when it is time to perform the second surgical step [5].