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

introductionAdequate 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.

methodsA 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.

resultsFive 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/

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