Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):352-356. 10.14701/ahbps.2020.24.3.352.

A minimally invasive first stage of ALPPS for hepatoblastoma in a child

• Akhaladze D
• Uskova N
• Rabaev G
• Kachanov D
• Grachev N

• KMID: 2505350
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.352

Abstract

Large and giant tumors, especially hepatoblastomas, are more frequently presented in pediatric patients. At about two-third of hepatoblastomas at the time of diagnosis are unresectable and liver transplantation is considered as a treatment of choice because of insufficient future liver remnant volume. In selected cases, 2-staged hepatectomy may be the unique chance for curative resection except hepatectomy followed by liver replacement. Despite the overwhelming spread of minimally invasive liver surgery, the laparoscopic approach remains uncommon in children. A case of successful partial associating liver partition with portal vein ligation for staged hepatectomy firstly accomplished pure laparoscopically on the first stage in an infant is presented. Described experience suggests both: the feasibility of laparoscopic procedures and the effectiveness of partial in situ liver splitting to reach appropriate future liver remnant volume and to avoid liver transplantation and its disadvantages.

Keyword

Mini ALPPS; Laparoscopic ALPPS; Children

Figure

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  Fig. 1 Initial CT, showing the tumor, involving 4,5,7,8 and 1 hepatic segments.

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  Fig. 2 (A) Ligated right portal vein. (B) Dissection of S4 portal branches. (C) Liver parenchymal transection.

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  Fig. 3 The extended right hepatectomy is completed. 1, remnant liver; 2, left hepatic artery; 3, left portal vein; 4, left hepatic duct; 5, biliary drainage; 6, inferior vena cava; 7, duodenum.

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  Fig. 4 The CT before 2nd stage surgery. 1, left hepatic vein; 2, distal right hepatic vein; 3, shunt between right and left hepatic veins; 4, umbilical fissure.

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