WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Fidele Kakule Kitaghenda* and Sakarie Mustafe Hidig

ABSTRACT

Background: Adequate visualization of the operative field and workspace is essential in laparoscopic bariatric surgery (LBS). Therefore, different methods have been described to retract the left lobe of the liver. This review aims to appraise all existing published data on liver retractor methods in LBS and assess their feasibility and associated complications. Methods: A systematic literature search was performed on PubMed, Google Scholar, and the Cochrane Library, to identify eligible retrospective and randomized clinical trial (RCT) studies conducted and published before June 2023. Data on different liver retraction methods in LBS and associated complications were included in this review. Results: A total of 16 studies met the inclusion criteria and 5096 patients were included in this review. Various liver retraction methods have been described in LBS. Traditional liver retractors (snake retractor, PretzeFlex, and Nathanson), were associated with significant liver function derangement, postoperative pain, and longer hospital stay. Portless liver retractor methods were shown to be effective, however, with an increased retraction fixation time and additional instruments. Conclusion: Traditional liver retractors have shown to be effective, however, with significant adverse effects on liver function, postoperative pain, longer hospital stays, and trocar port-associated complications. On the other hand, portless liver retractor methods have proved to be less traumatic and flexible to adapt to the many different aspects of foregut surgery with the implication for single-incision bariatric surgery.

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