This poster will cover: What ALPPS (Associating Liver Partition With Portal vein Ligation for Staged hepatectomy) involves. Normalradiological findings after ALPPS. Common post operative complication of ALPPS and the corresponding radiological findings.

Surgical resection remains the definitive treatment for primary and secondary liver malignancies.One of the main limiting factors inperforming a major hepatic resection is to ensure an adequate post-operative future liver remnant (FLR) volume in order to avoid post-hepatectomy liver failure1 (PHLF). In many cases the planned FLR volume is deemed insufficient to maintain hepatic function. Techniques such as portal vein embolization (PVE) and portal vein ligation (PVL) aims to induce hypertrophy in the FLR volume prior to resection. Current evidence is inconclusive as to which...

ALPPS involves a two-stage hepatectomy. The first stage involves right portal vein ligation (with preservation of the hepatic artery) and in situ splitting of the liver. This results in rapid hypertrophy4. Thesecond stage is usually performed after 10 days, and it involves interruption of the hepatic artery, hepatic veins and biliary drainage in a manner similar to a conventional right hepatectomy. Cross sectional imaging is usually performed one week after the first stage. The purpose of this is to measure the degree of hypertrophyand to...

ALPPS is a promising new development in the ever-challenging field of liver surgery. Its ability to induce quicker hypertrophy effectively reduces the waiting time to surgery, which may be at least 6-8 weeks following portal vein embolisation. The radiologists' role will include pre-operative tumour assessment for resectability, volumetric assessments, identification of any vascular or biliary variant anatomy, and assessment / treatment of postoperative complications.

1.Azoulay D, Castaing D, Smail A et al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein emboliszation. Ann Surg 2000; 231 (4): 480-486 2.Broering DC, Hillert C, Krupski G et al. Portal vein embolisation vs portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg 2002 (6): 905-913 3.Aussilhou B, Lesurtel M, Sauvanet A et al. Right Portal vein ligation is as efficient as portal vein embolisation to induce hypertrophy of the left liver remnant. J...