A new surgical strategy for multiple multiple bilobular liver metastases: right portal occlusion and torniquet in the parenchyma section line

• Published in: Cirugia Española Vol. 90; no. 3; p. 191
• Main Authors: Robles Campos, Ricardo, Paricio, Pascual Parrilla, Conesa, Asunción López, Hernández, Caridad Marín, Pérez, Rocío García, Quiñonero, Matilde Fuster
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.03.2012
• Subjects: Adult; Female; Gastrointestinal Stromal Tumors - blood supply; Gastrointestinal Stromal Tumors - pathology; Gastrointestinal Stromal Tumors - secondary; Gastrointestinal Stromal Tumors - surgery; Hepatectomy - methods; Humans; Liver Neoplasms - blood supply; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Portal Vein; Therapeutic Occlusion; Tourniquets
• ISSN: 1578-147X
• DOI: 10.1016/j.ciresp.2012.01.002

Right portal vein occlusion plus «in situ split» has recently been reported as a new method to hypertrophy the functional remnant volume (FRV) in 7 days after two-stage liver resection. It is a complex procedure associated with the occlusion of the intrahepatic collaterals between both lobes. We present an original technique for hypertrophying the FRV by occluding the right portal vein and the intrahepatic collaterals: a case is presented of a 35-year-old woman with an intestinal stromal tumour, 14 bilobar metastases and an estimated 24% FRV. Once the lesions were removed from the left lobe, we performed a right portal vein transection and applied a tourniquet on the Cantlie line, using the hanging manoeuvre. A 57% hypertrophy of the FRV was achieved by day 7, and the right hepatectomy was performed on day 8. Our technique is effective and simple to perform and if corroborated in future studies, this technique would be of choice in 2-stage liver resection.