Abstract
Purpose: We compared different liver retractors used in laparoscopic fundoplication (LF) and examined how the different choices affected operability, visual field, and postoperative liver function.
Methods: Eleven patients who underwent LF in our department between April 2013 and March 2015 were classified into 3 groups: the N method group (Nathanson liver retractor connected to an Octopus retractor holder, n = 3), the T method group (three-point extension with Teflon tape retraction, n = 5), and the V method group (two-point extension with thread and needle, n = 3). To investigate the difference between the three liver retraction methods, we measured the time required for each liver retraction method and the alanine aminotransferase (ALT) levels preoperatively and on postoperative day (POD) 1 for each method.
Results: The times required for liver retraction were 3.7 min for the N method group, 11.6 min for the T method group, and 10 min for the V method group. The N method group required the shortest time to retract the liver. In all groups, ALT levels on POD 1 significantly increased from preoperative ALT levels, and the V method group showed significantly lower POD 1 and preoperative ALT levels than the N and T method groups. The patients who showed high ALT levels (> 100 IU/l) were younger than those who showed low ALT levels (< 100 IU/l).
Conclusions: It is important to thoroughly understand and consider the merits and demerits of each method when choosing an appropriate method.
