Raffaele Brustia1,2, Olivier Scatton3,4, Olivier Soubrane5,6. 1. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. raffaele.brustia@gmail.com. 2. Université Pierre et Marie Curie, Paris, France. raffaele.brustia@gmail.com. 3. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 4. Université Pierre et Marie Curie, Paris, France. 5. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France. olivier.soubrane@aphp.fr. 6. Université Diderot, Paris, France. olivier.soubrane@aphp.fr.
Abstract
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) got wide success among hepatic surgeons as an efficient way to shorten to 7 days from the 4 weeks interval of classic 2-staged hepatectomy. The main disadvantage of ALPPS is the onset of inflammatory adhesions, particularly on the hepatic pedicle region, previously dissected. The aim of the study is the evaluation of a resorbable collagen membrane (CM) indicated in the prevention of postoperative adhesions as an alternative to the use of a plastic bag (PB) during ALPPS procedure. METHODS: All patients undergoing ALPPS procedure in our department were prospectively included in a database. At the end of the first surgery, at least one resorbable CM (COVA+™, Biom'Up, France) was placed instead of a PB. Intraoperative adhesions during the second step and clinical short-term safety were assessed. RESULTS: Ten patients with a mean age of 57.5 years underwent a 2-staged hepatectomy through ALPPS approach. At the second stage, 90 % of the patients experienced either grade-0 (no adhesion) or grade-I adhesions (mild adhesions easily divided). None of the reported complications were related to the use of the CM. CONCLUSION: To our knowledge, this is the first clinical study evaluating the use of an anti-adhesion resorbable CM as a safe and efficient alternative to PB in ALPPS procedures.
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) got wide success among hepatic surgeons as an efficient way to shorten to 7 days from the 4 weeks interval of classic 2-staged hepatectomy. The main disadvantage of ALPPS is the onset of inflammatory adhesions, particularly on the hepatic pedicle region, previously dissected. The aim of the study is the evaluation of a resorbable collagen membrane (CM) indicated in the prevention of postoperative adhesions as an alternative to the use of a plastic bag (PB) during ALPPS procedure. METHODS: All patients undergoing ALPPS procedure in our department were prospectively included in a database. At the end of the first surgery, at least one resorbable CM (COVA+™, Biom'Up, France) was placed instead of a PB. Intraoperative adhesions during the second step and clinical short-term safety were assessed. RESULTS: Ten patients with a mean age of 57.5 years underwent a 2-staged hepatectomy through ALPPS approach. At the second stage, 90 % of the patients experienced either grade-0 (no adhesion) or grade-I adhesions (mild adhesions easily divided). None of the reported complications were related to the use of the CM. CONCLUSION: To our knowledge, this is the first clinical study evaluating the use of an anti-adhesion resorbable CM as a safe and efficient alternative to PB in ALPPS procedures.
Authors: Andreas A Schnitzbauer; Sven A Lang; Holger Goessmann; Silvio Nadalin; Janine Baumgart; Stefan A Farkas; Stefan Fichtner-Feigl; Thomas Lorf; Armin Goralcyk; Rüdiger Hörbelt; Alexander Kroemer; Martin Loss; Petra Rümmele; Marcus N Scherer; Winfried Padberg; Alfred Königsrainer; Hauke Lang; Aiman Obed; Hans J Schlitt Journal: Ann Surg Date: 2012-03 Impact factor: 12.969
Authors: Aurélien Dupré; Anne Lefranc; Emmanuel Buc; Jean Robert Delpero; François Quenet; Guillaume Passot; Serge Evrard; Michel Rivoire Journal: Ann Surg Date: 2013-07 Impact factor: 12.969