Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA.
Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.
J Laparoendosc Adv Surg Tech A. 2021 Feb;31(2):194-202. doi: 10.1089/lap.2020.0388. Epub 2020 Jul 14.
Retrospective case-matched comparison of magnetic liver retraction to a bedrail-mounted liver retractor in bariatric surgery specifically targeting short-term postoperative outcomes, including pain and resource utilization. Retraction of the liver is essential to ensure appropriate visualization of the hiatus in bariatric surgery. Externally mounted retractors require a dedicated port or an additional incision. Magnetic devices provide effective liver retraction without the need of an incision. The sample consisted of primary and revisional bariatric surgery patients, including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD-DS) operations. Propensity score analysis was used to match patients with magnetic retraction to patients with a bedrail-mounted retractor with a 1:2 ratio using preoperative characteristics. Baseline characteristics and postprocedure outcomes were compared using two-sample -tests or Wilcoxon rank sum tests and chi-square or Fisher's exact test as appropriate. One hundred patients met inclusion criteria for the use of magnetic liver retraction (45 RYGB, 35 SG, 20 BPD-DS) with 196 suitable matched external retractor patients identified. Patients were matched and comparable for all preoperative characteristics except for transversus abdominus plane block (27% versus 47%). Patients in the magnet cohort had significantly decreased mean 12-hour postoperative pain scores (2.9 versus 4.2, = .004) and decreased hospital length of stay (LOS) (1.5 versus 1.9 days, = .005) while operating room supply were higher in the magnet cohort ($4600 versus $4213, = .0001). Magnetic liver retraction in bariatric surgery is associated with decreased postoperative pain scores, decreased hospital LOS, and increased operating supply costs.
回顾性病例匹配比较磁性肝牵引与床轨式肝牵引在减重手术中的短期术后结果，包括疼痛和资源利用。在减重手术中，肝脏的回缩对于确保裂孔的适当可视化至关重要。外部牵引器需要专用端口或额外的切口。磁性装置可提供有效的肝脏回缩，而无需切口。样本包括初次和修正性减重手术患者，包括 Roux-en-Y 胃旁路术（RYGB）、袖状胃切除术（SG）和胆胰分流术与十二指肠转流术（BPD-DS）。使用术前特征，通过倾向评分分析以 1:2 的比例将接受磁性牵引的患者与接受床轨式牵引的患者进行匹配。使用两样本 t 检验或 Wilcoxon 秩和检验以及适当的卡方或 Fisher 精确检验比较基线特征和术后结果。100 名患者符合使用磁性肝牵引的纳入标准（45 例 RYGB、35 例 SG、20 例 BPD-DS），并确定了 196 例合适的外部牵引器匹配患者。患者在所有术前特征上匹配且可比，除了腹横平面阻滞（27% 与 47%）。与外部牵引器组相比，磁体组患者的平均 12 小时术后疼痛评分（2.9 与 4.2，= 0.004）和住院时间（LOS）（1.5 与 1.9 天，= 0.005）明显降低，而磁体组的手术室供应费用更高（4600 美元与 4213 美元，= 0.0001）。在减重手术中，磁性肝牵引与术后疼痛评分降低、住院 LOS 缩短和手术供应成本增加有关。
