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- W2890765441 abstract "Background: Liver hypertrophy induced by partial portal vein ligation (PVL) is accelerated by adding parenchymal transsection (“ALPPS procedure”). Previous experiments suggested that transsection abrogates portal neocollateral formation between lobes. This preclinical experimental study in pigs tests the hypothesis that simultaneous ligation of portal and hepatic veins (PVL + HVL) of the liver functionally abrogates collateral formation as well and thereby also accelerates hypertrophy. Methods: Simultaneous PVL + HVL was performed in landrace pigs by simultaneously ligating portal veins and major hepatic veins with the help of intraoperative ultrasound and ligated using pledgeted transparenchymal sutures. Kinetic growth was compared to a model of PVL. The anatomy of the portal vein system was studied after 7 days using epoxy casts of the portal circulation. Portal vein flow and portal pressure were measured and Ki-67 staining was used to evaluate the proliferative response. Results: Pigs were randomized to PVL (n = 8) and PVL + HVL (n = 6). PVL + HVL was well tolerated, led to mild cytolysis and no necrosis in the portal vein deprived lobe. The portal vein supplied sector increases by 90 ± 22% after PVL + HVL compared to 29 ± 18% after PVL (p < 0.001). Collaterals to the deportalized liver developed after 7 days in both procedures, but were markedly reduced in PVL + HVL. Ki-67 staining at 7 days was comparable. Volume increase after PVL + HVL appeared comparable to a pig model of ALPPS estabablished before. Conclusion: This study shows that simultaneous PVL + HVL leads to accelerated hypertrophy comparable to ALPPS. The findings suggest that reduced collateral formation indeed is an important element of rapid hypertrophy. Simultaneous Bi-embolization of portal and hepatic veins may well replace ALPPS to increase the efficiency of regenerative liver surgery." @default.
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- W2890765441 date "2018-03-01" @default.
- W2890765441 modified "2023-10-16" @default.
- W2890765441 title "Double ligation of portal and hepatic veins achieves hypertrophy comparable to ALPPS - a study in pigs" @default.
- W2890765441 doi "https://doi.org/10.1016/j.hpb.2018.02.054" @default.
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