Differential advantage of liver retraction methods in laparoscopic fundoplication for neurologically impaired patients: a comparison of three kinds of procedures
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Mar 2020 · 1 min read
In brief
In brief
This comparative study evaluates three liver retraction methods during laparoscopic fundoplication in 43 neurologically impaired patients. The needle grasper method proved most time-efficient, while the crural suture method caused less liver trauma but required greater technical skill, suggesting method selection should be tailored to surgeon experience and patient anatomy.
Written by the GCMD Library team from the article.
Abstract
Aim of the study
Liver retraction during laparoscopic fundoplication is important for obtaining an optimal space. Several methods have been developed, but the risks and benefits are unclear. We compared three different approaches and evaluated their safety and utility.
Methods
Forty-three neurologically impaired patients who underwent laparoscopic fundoplication between 2005 and 2018 were classified into three groups: A, snake retractor method, n = 18; B, crural suture method, n = 13; C, needle grasper method, n = 12. Patients’ characteristics and outcomes were reviewed.
Main results
The liver retraction time was significantly shorter in group C than in A or B (p < 0.05). The operative times were shorter in groups B and C than in A. There were no significant differences in the liver enzyme levels. The liver enzyme levels increased temporarily but improved within a week. The C-reactive protein levels were significantly lower in group B than in A or C (p < 0.05).
Conclusions
The most convenient method was the needle grasper method, as the other two approaches create conflict with the operator’s forceps. The crural suture method damages the liver less, but requires higher surgical skill levels. It is important to select the appropriate method according to the operator’s skill and the patient’s size and deformity.