Bariatric and Metabolic International Surgery Centre, E-Da Hospital, 1, E-Da Rd, Jian-Shu Tsuen, Yan-Chau Shiang, Kaohsiung 824, Taiwan, ROC.
Surg Endosc. 2013 Feb;27(2):679-84. doi: 10.1007/s00464-012-2438-6. Epub 2012 Jul 7.
This study aimed to evaluate differences between three methods of liver retraction during laparoscopic Roux-en-Y Gastric bypass (LRYGB) and to compare novel liver retraction techniques with the traditional mechanical liver retractor in a randomized controlled trial.
In this study, 60 obese patients (26 males and 34 females) who underwent LRYGB between January and July 2010 were randomized to one of three groups (20 in each): group 1 (Nathanson liver retractor), group 2 (liver suspension tape), and group 3 (V-shaped liver suspension technique [V-LIST]). Data regarding demographics (age, sex, body mass index); liver function test (LFT) just before surgery; postoperative results immediately, then 18 h, 1 week, and 1 month after surgery; operative data, and visual analog scale (VAS) for pain on postoperative days (PODs) 1 and 2 were calculated and analyzed.
The groups did not differ significantly in terms of preoperative LFT or operative data except that group 3 took significantly longer time for liver suspension than group 1 (p = 0.01) or group 2 (p = 0.03). The VAS score in group 2 was significantly lower on POD 1 than in group 1 (p = 0.04). Group 1 showed a significant rise in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at 18 h compared with group 2 (p < 0.01 and p = 0.02, respectively) and group 3 (p < 0.01 and p = 0.01), at 1 week compared with group 2 (p = 0.04 and 0.04), and in AST levels alone during the immediate postoperative compared with group 3 (p = 0.04).
The Nathanson liver retractor causes more liver dysfunction than V-LIST or the liver suspension technique and causes more postoperative pain than the liver suspension technique. Both V-LIST and liver suspension tape have a short learning curve and implications for single-port surgery.
本研究旨在评估腹腔镜 Roux-en-Y 胃旁路术（LRYGB）中三种肝脏牵引方法之间的差异，并在随机对照试验中比较新型肝脏牵引技术与传统机械肝脏牵引器。
本研究纳入 2010 年 1 月至 7 月期间行 LRYGB 的 60 例肥胖患者（男 26 例，女 34 例），随机分为三组（每组 20 例）：组 1（Nathanson 肝脏牵引器）、组 2（肝脏悬吊带）和组 3（V 形肝脏悬吊技术[V-LIST]）。记录人口统计学数据（年龄、性别、体重指数）；手术前肝功能检查（LFT）；术后即刻、术后 18 小时、1 周和 1 个月的结果；手术数据和术后第 1 天和第 2 天的视觉模拟评分（VAS）用于疼痛。
除组 3 肝脏悬吊时间明显长于组 1（p=0.01）或组 2（p=0.03）外，三组间术前 LFT 或手术数据无显著差异。组 2 术后第 1 天的 VAS 评分明显低于组 1（p=0.04）。与组 2（p<0.01 和 p=0.02）和组 3（p<0.01 和 p=0.01）相比，组 1 在术后 18 小时时天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）明显升高，与组 2 相比（p=0.04 和 0.04）和组 3（p<0.01 和 p=0.01）相比，在术后 1 周时 AST 水平升高，与组 3 相比，术后即刻时 AST 水平升高（p=0.04）。
Nathanson 肝脏牵引器引起的肝功能障碍比 V-LIST 或肝脏悬吊技术多，引起的术后疼痛比肝脏悬吊技术多。V-LIST 和肝脏悬吊带都有一个短的学习曲线，并对单端口手术有影响。
