The First Total Situs Inversus Patient Treated with Extended Two-Step Hemihepatectomy

Background: Liver resection is the treatment of choice for patients with primary or secondary liver tumors restricted to the liver. Resection is limited, however, by the need to preserve a sufficient amount of functional remnant liver. If future remnant liver volume (FRLV) is deemed to be small for extended right hepatectomy, occlusion of the right portal vein may induce growth of the left hemi-liver and enable hepatectomy within to ore more months.Case Report: We present the first reported case of extended left hemihepatectomy in a patient with total situs inversus. In a first step, we did not only divide the right portal vein and bile duct, but also performed parenchymal dissection to induce even more rapid liver growth and perform the final hepatectomy within ten days after the first surgery. The patient underwent two-step hemi-hepatectomy and we observed 63% increase in size of FRLV after ten days. Liver function tests showed functional FLRV and hepatectomy was performed eight days after the first surgery. In the biopsies from the remnant liver we observed hypertrophy and hyperplasia of hepatocytes but not edema. Repeated computed tomography showed further growth of remnant liver up to 200% of initial FRLV after 3 weeks.Conclusions: We propose the described two-step hepatectomy as an alternative to conventional portal vein occlusion and resection within two or more months, because hepatectomy may be completed within ten days not allowing for tumor growth or spread within this short period.