title: A protective technique for retraction of the liver during laparoscopic gastrectomy for gastric adenocarcinoma: using a Penrose drain.
abstract: BACKGROUND
  Retraction of the liver is necessary to ensure an adequate working space in laparoscopic surgery, but the retraction force applied may cause transient liver dysfunction. We have introduced the technique using a Penrose drain to suspend the liver with the performance of laparoscopic gastrectomy for gastric adenocarcinoma.
  
  
  METHODS
  111 patients with gastric adenocarcinoma underwent laparoscopic gastrectomy using either a Penrose drain (n = 47) or a Nathanson's retractor (n = 64) for displacement of the liver. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, alkaline phosphatase (ALP) and albumin were compared among the groups at baseline, immediately after operation, and on postoperative days (POD) 1, 2, 3, 5, and 7.
  
  
  RESULTS
  The levels of ALT on POD 2, 3, and 5 were significant higher in the Nathanson's retractor group than in the Penrose drain group. Levels of AST on POD 2 and 3 were also higher in the Nathanson's retractor group than in the Penrose drain group. There was no significant difference in total bilirubin, ALP, and serum albumin levels between groups.
  
  
  CONCLUSIONS
  The use of the Penrose drain for retraction of the liver appears to attenuate postoperative liver dysfunction during laparoscopic gastrectomy for gastric adenocarcinoma.
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, 470-1192, Aichi, Japan. shinohara@jikei.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shinohara
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kanaya
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Yoshimura
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hiramatsu
authors.forename: Shusuke
authors.initials: S
authors.lastname: Haruta
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Simone
authors.initials: S
authors.lastname: Giacopuzzi
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Fujita
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008099:Liver / Q000293:injuries* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D013525:Surgical Instruments
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