論文

査読有り 国際誌
2020年5月

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

36
5
開始ページ
591
終了ページ
596
記述言語
英語
掲載種別
研究論文(学術雑誌)
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.

リンク情報
DOI
https://doi.org/10.1007/s00383-020-04646-8
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/32198620

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