The use of a NHS-PEG coated, collagen-based sealant in a patient undergoing Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS). (2018)

• Record Type: Journal Article
• Authors: Olthof, Pim B.; Rassam, Fadi; van Gulik, Thomas M.
• Is Part Of: International journal of surgery case reports. Volume 47(2018)
• Page Start: 7
• Page End: 10
• Publication Date: 2018
• Subjects: Hemopatch -- Case report -- ALPPS; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.03.038
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: ALPPS is a two stage hepatectomy with rapid liver hypertrophy. ALPPS had high morbidity and mortality rates compared to conventional procedures. Interstage morbidity is especially predictive of mortality after ALPPS. Topical hemostatic agents might reduce interstage morbidity. Abstract: Introduction: ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) is a new two-stage hepatectomy for patients in whom conventional treatment is not feasible due to insufficient future liver remnant (FLR). During stage one of ALPPS, accelerated growth of the FLR is induced by ligation of the portal vein and in situ split of the liver, which prevents interlobar collateral portal circulation and attributes to the accelerated hypertrophy response. This can present a risk for postoperative haemorrhage. Furthermore, adhesion of the adjacent resection surfaces might complicate the second stage of the procedure. Hemopatch ® is a flexible, NHS-PEG coated, absorbable collagen-based sealant that provides haemostasis. This paper illustrates the use of Hemopatch during ALPPS for hemostasis and prevention of adhesions between the cut-surfaces of the liver. Presentation of case: An 81-year-old patient requiring right hemihepatectomy for synchronous liver metastases underwent ALPPS. During stage one, Hemopatch was applied according to the manufacturer's instructions to the hepatic resection surfaces. Stage-2 was performed uneventfully, with no adhesions observed in the resection plane 18 days after the first stage. The patient was discharged without any major complications. Discussion: Hemopatch is a useful tool in prevention of postoperative haemorrhage in patients undergoing ALPPS procedure as well as in the prevention of adhesions between the cut-surfaces after transection. This facilitates stage-2 of the procedure which potentially improves postoperative outcomes. Conclusion: Topic haemostatic agents to cover the transection surface during stage one of ALPPS could help to prevent adverse interstage events.