Transition from open to laparoscopic ALPPS for patients
with very small FLR: the initial experience

Marcel Autran Machado, MD, FACS, Rodrigo C. Surjan, MD, Tiago Basseres, MD, Fabio F. Makdissi, MD, Erik Schadde, MD, FACS

HPB 2016 http://dx.doi.org/10.1016/j.hpb.2016.10.004




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Background: Laparoscopic ALPPS (Associating Liver Partition and Portal vein ligation for Staged
hepatectomy) has been reported in individual reports, but has been the authors’ default option since
Methods: A retrospective analysis of all consecutive patients undergoing ALPPS at a single referral
center was performed using a prospective database from July 2011 to June 2016. Feasibility was studied
by assessing conversions. The 90-day mortality and complications were analyzed using a Dindo–Clavien
score and the comprehensive complication index. Operative time, blood loss, volumetric growth, and
hospital stay were examined. The CUSUM statistic was measured.
Results: There was no mortality and no complication grade �3A observed in laparoscopic ALPPS. In
open ALPPS, one patient died after the procedure and 10 out of 20 patients experienced complications
grade �3A (p = 0.006). No liver failure was observed after laparoscopic ALPPS, and two patients in the
open ALPPS developed complications that precluded the second stage. The hospital stay was shorter in
the laparoscopic ALPPS group.
Conclusion: Laparoscopic ALPPS is feasible as the default procedure for patients with very small FLR,
and it is not inferior to the open approach. The use of laparoscopy in ALPPS should be encouraged to
surgeons experienced with complex laparoscopy.