title: Randomized controlled trial comparing three methods of liver retraction in laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, 1, E-Da Rd, Jian-Shu Tsuen, Yan-Chau Shiang, Kaohsiung 824, Taiwan, ROC.
authors: Rajat
authors: R
authors: Goel
authors: Asim
authors: A
authors: Shabbir
authors: Chi-Ming
authors: CM
authors: Tai
authors: Alvin
authors: A
authors: Eng
authors: Hung-Yen
authors: HY
authors: Lin
authors: Su-Long
authors: SL
authors: Lee
authors: Chih-Kun
authors: CK
authors: Huang
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008099:Liver; D008297:Male