Differential Advantage of Liver Retraction Method in Laparoscopic Fundoplication - Effectiveness of Fine Needle Devices

Differential Advantage of Liver Retraction Method in Laparoscopic Fundoplication – Effectiveness of Fine Needle Devices

Toshio Harumatsu, MD, Masakazu Murakamai, MD, Keisuke Yano, MD, Tokuro Baba, MD, Shun Onishi, MD, PhD, Koji Yamada, MD, Waka Yamada, MD, PhD, Ryuta Masuya, MD, PhD, Seiro Machigashira, MD, Kazuhiko Nakame, MD, PhD, Motoi Mukai, MD, PhD, Tatsuru Kaji, MD, PhD, Satoshi Ieiri, MD, PhD, FACS. Department of Pediatric Surgery, Kagoshima University

Background: Liver retraction during laparoscopic fundoplication is important for obtaining an optimal space. There are some kinds of methods, which risk and benefit are unclear. We compared 3 different liver retraction method and evaluated their safety and utility.

Method: Forty-nine patients who underwent laparoscopic fundoplication in our institution between 2005 and 2018 were included. Patients were classified into three groups (A, B and C) based on the liver retraction method. A: Snake retractor, n=19. B: The hepatic crown suture, n=20. C: The diaphragm gripping by the 2. 4mm forceps, n=10. Patients’ characteristics, operative data and postoperative outcomes were reviewed based on medical record.

Result: Patients’ characteristics and clinical data were shown in Table 1. The time requiring the liver retraction of 2. 4mm grasper was significantly shorter than hepatic crown suture. There was no significant difference in blood loss and liver enzyme elevation in 3 groups. The serum liver enzymes elevated temporarily, but improved within a week in all groups as shown in Figure 1. T-Bil and CRP levels were lower in the group B than A. No serious complications associated with liver retraction were recognized in all group, but the pancreatic enzyme was elevated about 10% patients in all group.

Conclusion: Most convenient methods is grasping diaphragm. But snake retractor and grasper have the confliction with operator’s forceps depending of patients’ size. Hepatic crown suture do less damage to liver, but require the technique. It is important to select the appropriate method according to operator’s skill and patients’ body condition such as size and deformity.