Skip to main content
SpringerLink
Log in

Comparison of the Pretzelflex Retractor and Nathanson Retractor in Laparoscopic Sleeve Gastrectomy Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

Retraction of the left lobe of the liver is an important step in most bariatric surgical procedures. The left lobe of the liver may be enlarged, and laceration, hematoma, or necrosis may develop in the liver due to retraction. In this study, the results of use of the Nathanson retractor (NR) and PretzelFlex retractor (PFR) in the patients undergoing laparoscopic sleeve gastrectomy (LSG) were compared.

Materials and Methods

The patients who underwent LSG were divided into three groups based on the type of liver retraction device used. Group 1: NR was used fixed during the operation; Group 2: PF retractor was used; Group 3: NR were used only for fundus dissection and when necessary. All groups were evaluated in terms of demographic characteristics, liver function tests, and developing complications.

Results

The study was conducted with a total of 120 consecutive patients. Operation time in the second group was found to be significantly lower than the other two groups (p = 0.009; p = 0.001; p < 0.01). The duration of retractor use in the first group was significantly higher than the other two groups (p = 0.001; p = 0.001; p < 0.01). While aspartate aminotransferase (AST) values were found to be high in Group 1, alanine aminotransferase (ALT) values were found to be high in Groups 1 and 3.

Conclusion

PFR has shorter operating and retraction times. It causes less measurable liver damage. Although the NR will be used, intermittent use causes less damage to the liver as in PFR.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pasenau J, Mamazza J, Schlachta CM, Seshadri PA, Poulin EC. Liver hematoma after laparoscopic Nissen fundoplication: a case report and review of retraction injuries. Surg Laparosc Endosc Percutan Tech. 2000;10:178–81.

    Article  CAS  Google Scholar 

  2. Sweeny A, Buglino L, La Vella E, Yarbrough D. Comparison of a novel, trocar-free ınternal liver retractor to standard liver retraction in bariatric surgery. Obes Surg. 2019;29:3071–5.

    Article  Google Scholar 

  3. Nguyen NT, Longoria M, Gelfand DV, Sabio A, Wilson SE. Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg. 2005;15:1077–81.

    Article  Google Scholar 

  4. Ahmad A, Arellano JJ, Agarwala A, Ahmad Z, Ahmad Z. A percutaneous technique of liver retraction in laparoscopic bariatric & upper abdominal surgery. Surg Obes Relat Dis. 2016;12:1626–9.

    Article  Google Scholar 

  5. Huang CK, Lo CH, Asim S, Houng JY, Huang SFA. novel technique for liver retraction in laparoscopic bariatric surgery. Obes Surg. 2011;21:676–9.

    Article  Google Scholar 

  6. Goel R, Shabbir A, Tai CM, et al. Randomized controlled trial comparing three methods of liver retraction in laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2013;27:679–84.

    Article  Google Scholar 

  7. Morris-Stiff G, Jones R, Mitchell S, Barton K, Hassn A. Retraction transaminitis: an inevitable but benign complication of laparoscopic fundoplication. World J Surg. 2008;32:2650–4.

    Article  Google Scholar 

  8. Yassa NA, Peters JH. CT of focal hepatic injury due to surgical retractor. Am J Roentgenol. 1996;166:599–602.

    Article  CAS  Google Scholar 

  9. Midya S, Ramus J, Hakim A, Jones G, Sampson M. Comparison of two types of liver retractors in laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2020 Jan;30:233–7.

    Article  Google Scholar 

  10. Capizzi FD, Boschi S. Brulatti M et al Laparoscopic adjustable esophagogastric banding: preliminary results. Obes Surg. 2002;12:391–4.

    Article  Google Scholar 

  11. Teixeira J, McGill K. Koshy N et al Laparoscopic singlesite surgery for placement of adjustable gastric band: a series of 22 cases. Surg Obes Relat Dis. 2010;6:41–5.

    Article  Google Scholar 

  12. Etoh T, Shiraishi N, Tajima M, et al. Transient liver dysfunction after laparoscopic gastrectomy for gastric cancer patients. World J Surg. 2007;31:1115–20.

    Article  Google Scholar 

  13. Jeong GA, Cho GS, Shin EJ, et al. Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance. World J Gastroenterol. 2011;17:372–8.

    Article  Google Scholar 

  14. Kotake Y, Takeda J, Matsumoto M, et al. Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy. Br J Anaesth. 2001;87:774–7.

    Article  CAS  Google Scholar 

  15. Morino M, Giraudo G, Festa V. Alterations in hepatic function during laparoscopic surgery. An experimental clinical study Surg Endosc. 1998;12:968–72.

    CAS  PubMed  Google Scholar 

  16. Morris LF, Ragavendra N, Yeh MW. Evidence-based assessment of the role of ultrasonography in the management of benign thyroid nodules. World J Surg. 2008;32:1253–63.

    Article  Google Scholar 

  17. Lohlun JC, Guirguis A, Wise L. Elevated liver enzymes following open Roux-en-Y gastric bypass for morbid obesity—does timing of liver retraction affect the rise in the levels of transaminases? Obes Surg. 2004;14:505–8.

    Article  Google Scholar 

  18. Okano S, Sawai K, Taniguchi H, et al. Aberrant left hepatic artery arising from the left gastric artery and liver function after radical gastrectomy for gastric cancer. World J Surg. 1993;17(1):70–3 (discussion 74).

    Article  CAS  Google Scholar 

  19. Ushimaru Y, Omori T, Fujiwara Y, et al. A novel liver retraction method in laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2018;33:1828–36.

    Article  Google Scholar 

  20. Tamhankar AP, Kelty CJ, Jacob G. Retraction-related liver lobe necrosis after laparoscopic gastric surgery. JSLS. 2011;15(1):117–21.

    Article  Google Scholar 

  21. Shibao K, Higure A, Yamaguchi K. Disk suspension method: a novel and safe technique for the retraction of the liver during laparoscopic surgery. Surg Endosc. 2011;25:2733–7.

    Article  Google Scholar 

  22. Kitajima T, Shinohara H, Haruta S, et al. Prevention of transient liver damage after laparoscopic gastrectomy via modification of the liver retraction technique using the Nathanson liver retractor. Asian J Endosc Surg. 2015;8:413–8.

    Article  Google Scholar 

  23. Yousuke K, Hiroshi O, Kazutaka O, et al. Elevation of liver function tests after laparoscopic gastrectomy using a Nathanson liver retractor. World journal of surgery. 2011;35(12):2730–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Fatih Sultan Mehmet Training And Research Hospital/General Surgery, Hastane Street No: 1/8 Icerenkoy, 34752, , Istanbul, Turkey

    Mehmet Mahir Fersahoğlu, Anıl Ergin, Hüseyin Çiyiltepe, Ayşe Tuba Fersahoglu, Nuriye Esen Bulut, Ali Cihan Bilgili & Kemal Memişoğlu

  2. Hisar Intercontinental Hospital/General Surgery, Saray Mahallesi Siteyolu caddesi no:7, 34768, Umraniye/Istanbul, Turkey

    Bülent Kaya

Authors
  1. Mehmet Mahir Fersahoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anıl Ergin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hüseyin Çiyiltepe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ayşe Tuba Fersahoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nuriye Esen Bulut
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Cihan Bilgili
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bülent Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kemal Memişoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Mahir Fersahoğlu.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

• One of the biggest problems experienced by surgeons during LSG is retraction of the liver.

• There are many types of retractors used for liver retraction, and the continuous use of these retractors throughout the surgery causes liver ischemia.

• Intermittent use of the PFR and NR reduces ischemia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fersahoğlu, M.M., Ergin, A., Çiyiltepe, H. et al. Comparison of the Pretzelflex Retractor and Nathanson Retractor in Laparoscopic Sleeve Gastrectomy Surgery. OBES SURG 31, 4963–4969 (2021). https://doi.org/10.1007/s11695-021-05680-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-021-05680-8

Keywords

Search

Navigation