Evaluation of early postoperative liver dysfunction associated with liver retraction method in laparoscopic gastrectomy Nobuo TAKATA 1 , Takahiro KINOSHITA 1 , Hidehito SHIBASAKI 1 , Hideki SUNAGAWA 1 , Naoki ENOMOTO 1 , Toshiro NISHIDA 1 1Gastric Surgery Division, National Cancer Center Hospital East Keyword: 腹腔鏡下胃切除 , 肝挙上 , 術後肝障害 pp.599-605
Published Date 2015/11/15
DOI https://doi.org/10.11477/mf.4426200188
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[Purpose] The aim of this study is to evaluate the relation between liver retraction methods and early postoperative liver dysfunction in laparoscopic gastrectomy. [Patients and Methods] Clinical data of 277 patients, who underwent laparoscopic gastrectomy for gastric cancer from September 2010 to May 2013, were retrospectively reviewed for analysis. Liver retraction was performed in one of the following ways : hanging method(hang up the liver by a T-shaped Penrose drain), suture-fixed method(fixed a Penrose drain to the diaphragmatic crus using a suture at its middle point), or snake retractor method. We analyzed postoperative changes of the serum AST, ALT and T-Bil as parameters indicating liver dysfunction. Multivariable analysis was also conducted to clarify the specific factors related with postoperative liver dysfunction. [Result] The increase rates of AST and ALT were significantly lower in suture-fixed method and snake retractor method than in hanging method. The increase rate of T-Bil was significantly lower in suture-fixed method than in other two methods. Multivariable analysis revealed that hanging method and high BMI were independent predictive factors for liver dysfunction. [Conclusion] From a viewpoint to prevent postoperative liver dysfunction, our results indicate that suture-fixed method is an ideal method at present.

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