Papers

Peer-reviewed International journal
May, 2020

Differential advantage of liver retraction methods in laparoscopic fundoplication for neurologically impaired patients: a comparison of three kinds of procedures.

Pediatric surgery international
  • Toshio Harumatsu
  • ,
  • Taichiro Nagai
  • ,
  • Keisuke Yano
  • ,
  • Shun Onishi
  • ,
  • Koji Yamada
  • ,
  • Waka Yamada
  • ,
  • Makoto Matsukubo
  • ,
  • Mitsuru Muto
  • ,
  • Tatsuru Kaji
  • ,
  • Satoshi Ieiri

Volume
36
Number
5
First page
591
Last page
596
Language
English
Publishing type
Research paper (scientific journal)
DOI
10.1007/s00383-020-04646-8

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.

Link information
DOI
https://doi.org/10.1007/s00383-020-04646-8
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/32198620
ID information
  • DOI : 10.1007/s00383-020-04646-8
  • Pubmed ID : 32198620

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