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Comparison of a Novel, Trocar-Free Internal Liver Retractor to Standard Liver Retraction in Bariatric Surgery

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Abstract

Introduction

Adequate liver retraction is an essential step in bariatric surgery, with technical challenges due to an enlarged, fatty liver. Traditional methods utilize externally fixed, rigid retractors with inherent drawbacks including an extra incision, pain, scarring, and liver injury. Advancement of laparoscopic techniques for liver retraction methods has focused on simplicity, reproducibility, safety, and effective use to avoid patient comorbidity. Our study is a retrospective evaluation of the safety and efficacy of a totally internal, atraumatic bulldog liver retractor versus standard retraction in a large series of patients undergoing laparoscopic bariatric surgery.

Methods

A retrospective chart review was performed on all patients undergoing bariatric surgery from April 2010 to December 2017. Standard retraction was used in 108 subjects and a bulldog retractor system attached to the pars flaccida, and anterior abdominal wall was used in 483 subjects. Any operations with additional procedures, re-do operations, or missing data were excluded.

Results

Five hundred fifty-one procedures were included between 2010 and 2017. In unadjusted analysis, no significant differences were found in AST/ALT elevation, need for additional retraction, length of stay (LOS), or operative times between the bulldog and standard retraction. Adjustment for demographics and Roux-en-Y gastric bypass versus sleeve gastrectomy in a multivariable logistic regression model, the standard retractor showed higher odds of AST/ALT elevation post-op and higher odds of needing additional retraction compared with those of the bulldog retractor.

Discussions/Conclusion

The bulldog retractor system can be used safely and effectively to expose the gastroesophageal junction in morbidly obese patients with advancements on the customary approach.

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Acknowledgements

Olivia Pipitone, MPH—for assistance with statistical analysis and table design. Gregory Showell, RN—for assistance with data collection.

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Authors and Affiliations

  1. Department of Surgery, Samaritan Weight Management Institute, 4655 NE Elliott Circle, Corvallis, OR, 97330, USA

    Andrew Sweeny, Larry Buglino III, Erika La Vella & Don Yarbrough

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  1. Andrew Sweeny
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  2. Larry Buglino III
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  3. Erika La Vella
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  4. Don Yarbrough
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Corresponding author

Correspondence to Andrew Sweeny.

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Conflict of Interest

Andrew Sweeny, Larry Buglino III, and Erika La Vella declare that they have no conflicts of interest.

Don Yarbrough reports a stipend from Intuitive Surgical for proctoring surgeons on robotic surgery outside the submitted work.

Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed Consent Statement

Our study was reviewed by our IRB and confirmed as “exempt” from further informed consent for this type of study.

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Sweeny, A., Buglino, L., La Vella, E. et al. Comparison of a Novel, Trocar-Free Internal Liver Retractor to Standard Liver Retraction in Bariatric Surgery. OBES SURG 29, 3071–3075 (2019). https://doi.org/10.1007/s11695-019-04049-2

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