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

Abstract 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 2015. 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.