Midlle age Young female complained abdominal pain and giant mass in right superior quadrant of the abdomen was referred to our unity. She presented an over-weight besides that alcoholic use (social) and positive Vírus B serology. She presented no comorbities.
CT and MRI showed 3 hipervascular lesions between 4 to 12 cm in both hepatic lobes compatible with telangiectatic adenomas (following localizations = central lesion 4 cm in segment VI, central lesion 12 cm in segments V+VIII and peripheric lesion 5,2 cm in segments II+III) . Hepatic function laboratorial tests were normal except gama-gt and alcaline phosphatase.
We have indicated surgical treatment, however after CT volumetry was observed just 16 % of FLR to resect all lesions in a single procedure. So we have proposed a two-stage hepatectomy with portal embolization.
She underwent this succesfull strategy:
1) Non-anatomical laparoscopic resection of left lobe adenoma;
2) Portal embolization of right portal vein and segment IV branchies,
and finally 3) Open Right Trisectioniectomy by anterior approach and total vascular exclusion of the liver.
Nowadays, She is assyptomatic and well with a good quality of her life
First step - laparoscopic non anatomic resection from 5,2 cm adenoma in left lobe.
Second Step - after portal embolization - Open Right Trisectioniectomy.
I think is one of the best therapeutic options for resolving these difficult cases
I use this surgical approach with pre operative volumetry study of the remaining liver before and after embolisation .
A very nice job, Sergio.
My only doubt is why you did a right trisectionectomy when S IV was not affected as you describe in your presentation. Wasn´t it possible to perform a right hepatectomy including or not the MHV depending on the relationship with the central tumor?
Nice case, anyway. Thank you
The midle hepatic vein presented strong adherences so we have wanted to sacrify it and segment iv presented very small volume.
Thanks for your quick answer.
Sergio, are you more prone to perform two stage surgery with portal embolization or ALPPS?
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