Background : ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) is becoming more established for the management of colorectal liver metastases where a future liver remnant is not deemed sufficient. Our institute has expanded into performing the challenging procedure laparoscopically.

Methods : A retrospective analysis of all consecutive patients undergoing ALPPS at a single referral center (Dr George Mukhari Academic hospital) for colorectal liver metastases with a small future liver remnant was performed using a prospective database from January 2020 till August 2021. Feasibility was assessed by analysis of conversions. The 90-day mortality and complications were analyzed using the Clavien-Dindo scoring system. Operative time, blood loss, volumetric growth and hospital stay were all studied.

Results : Laparoscopic ALPPS was performed in 3 patients. There was no mortality and no complication grade greater than IIIb was observed. One patient required a relook laparoscopy for sepsis at the site of the liver partition. Liver failure was not observed in any of the patients. The average hospital stay was 20 days.

Conclusions : Laparoscopic ALPPS is a feasible procedure in patients with colorectal liver metastases and a small future liver remnant. It is a complex procedure requiring significant resources and skill, but it is definitely feasible within the South African setting