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Modified Technique of Total Hepatectomy in Polycystic Liver Disease With Caval Flow Preservation

The Exposure Left Lateral Sectionectomy

Le Roy, Bertrand MD1,2; Cauchy, François MD1; Sepulveda, Ailton MD1; Yoh, Tomoaki MD, PhD1; Dokmak, Safi MD1; Weiss, Emmanuel MD, PhD3; Cesaretti, Manuela MD1; Durand, Francois MD4; Francoz, Claire MD4; Dondéro, Fédérica MD1; Soubrane, Olivier MD, PhD1

doi: 10.1097/TP.0000000000002538
Original Clinical Science—Liver

Background. Liver transplantation (LT) for polycystic liver disease (PLD) is rare, extremely challenging and hemorrhagic, without standard approach. Moreover, LT for PLD presents the highest mortality rate (12% to 18%) among all causes of LT. In this setting, the combination of difficult mobilization of a heavy polycystic native liver with narrow access to inferior vena cava and fragile venous wall may lead to venous tearing and cataclysmic bleeding during dissection. The aim of this study was to evaluate a modified technique of total hepatectomy to limit hazardous liver manipulation and improve exposure of inferior vena cava in patients with massive hepatomegaly related to PLD: the exposure left lateral sectionectomy (ELLS).

Methods. From 2011 to 2018, ELLS was performed during LT for PLD. Key technical points for safe and fast ELLS include avoidance of left triangular ligament section and placement of a tape behind the left lateral section allowing its ascension and prior dissection of the hepatic pedicle to limit bleeding. The transection plane is mainly composed of cysts, with limited parenchyma, which allows for rapid and bloodless transection using electric scalpel.

Results. Fifteen patients had ELLS with no postoperative death or intraoperative complication. Median ELLS duration was 16 minutes, and no massive bleeding occurred during this step. During total hepatectomy, median blood loss was 500 mL, and no patient required total caval clamping. All patients were alive at the end of the follow-up.

Conclusions. ELLS during LT for PLD facilitates total hepatectomy with vena cava and caval flow preservation.

1 Département de Chirurgie Hépato-pancréato-biliaire, AP-HP Hôpital Beaujon, Clichy, France.

2 Département de Chirurgie hépatobiliaire, Hôpital Estaing, CHU Clermont-Ferrand, France.

3 Département d’Anesthésie et Réanimation, AP-HP Hôpital Beaujon, Clichy, France.

4 Département d’Hépatologie, AP-HP Hôpital Beaujon, Clichy, France.

Received 6 September 2018. Revision received 17 October 2018.

Accepted 29 October 2018.

F.C., O.S., and F.D. participated in research design. B.L.R., O.S., and F.D. participated in the writing of the article. O.S., F.C., and T.Y. participated in the performance of the research. S.D., E.W., M.C., and C.F. contributed new reagents or analytic tools. A.S., F.D., S.D., E.W., M.C., and C.F. participated in data analysis.

The authors declare no funding or conflicts of interest.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Olivier Soubrane, MD, PhD, Département de Chirurgie Hépato-pancréato-biliaire, AP-HP Hôpital Beaujon, Clichy, 100 Boulevard du Général Leclerc, 92210 Clichy, France. (

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