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    A comparative analysis of the liver retraction with long surgical gauze in three-port sleeve gastrectomy and the four-port nathanson retractor technique
    (2025) Ertekin, Süleyman Çağlar; Önsal, Ufuk; Turgut, Emre; Akyol, Hüseyin; Ünver, Mutlu; Demirpolat, Muhammed Taha; Akbulut, Gökhan
    Background: This study evaluated the long surgical gauze (SurG) technique as a liver retraction method in laparoscopic sleeve gastrectomy (LSG). Traditional methods involve the Nathanson retractor, associated with ischemia and necrosis complications. In addition, these techniques require an additional trocar with an incision that increases postoperative pain. Our aim, therefore, was to reduce such complications through the use of SurG and evaluate recovery and outcome implications. Methods: In this retrospective study, patients who underwent laparoscopic sleeve gastrectomy (LSG) between January and December 2023 were divided into two groups based on the liver retraction method used: NR or SurG. Demographic data, surgery times, postoperative liver enzyme levels (AST, ALT), C-reactive protein (CRP), pain scores, and analgesic use (VAS) were collected from medical records and statistically analyzed. Results: The SurG group demonstrated significantly lower postoperative pain scores and reduced analgesic use compared to the NR group (p < 0.001). Additionally, liver enzyme levels (AST, ALT, CRP) were lower in the SurG group, indicating less liver stress. Early mobilization was achieved more quickly in the SurG group, aligning with Enhanced Recovery After Surgery (ERAS) protocols. However, the SurG method showed some limitations during the dissection of the greater curvature due to the narrower field of view. Conclusions: The long surgical gauze method provides a viable alternative to the Nathanson retractor, offering advantages such as less postoperative pain, reduced liver stress, and quicker mobilization. Despite some technical limitations, this method can improve patient outcomes in sleeve gastrectomy.
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    Öğe
    Evaluation of veress needle as a liver retraction technique in laparoscopic sleeve gastrectomy
    (2024) Ertekin, Süleyman Çağlar; Akbulut, Gökhan; Turgut, Emre; Akyol, Hüseyin; Ergenç, Muhammer; Yeğen, Cumhur
    Background: Liver retraction management in laparoscopic sleeve gastrectomy (LSG) is challenging for surgeons, especially in patients with enlarged livers. Traditional methods, such as the Nathanson retractor (NR), often necessitate additional incisions, potentially increasing liver enzymes and increasing the risk of complications. The aim of this study was to evaluate the efficacy of the use of a Veress needle (VN), an alternative liver retraction technique, in LSG surgery compared with NR. Materials and methods: This study was conducted at a university-affiliated hospital between May 2022 and December 2022. Patients who underwent LSG were divided into two groups: one utilizing the NR and the other employing the VN for liver retraction. Parameters such as operation duration, retraction time, liver laceration, trocar-induced hemorrhage, subxiphoid trocar site infections, pain scores measured via the visual analog scale (VAS) at various time points, pre- and postoperative liver enzyme levels (AST, ALT, GGT, ALP) and CRP levels were analyzed. Results: Data from 151 patients were analyzed. The AST/ALT elevations (P < 0.001) were significantly lower in the VN group (73 patients) than in the NR group (78 patients), while there was no significant difference in GGT/ALP levels. Retraction-related bleeding was significantly greater in the NR group than in the VN group (6.4% vs 0%, P = 0.035). Postoperative infection rate was lower in the VN group but not statistically significant (0% vs 3.8%, P = 0.135). CRP differences were significant on the first postoperative day (P < 0.001). Postoperative VAS scores were significantly lower in the VN group at all measured time points except at the 48th hour and 10th day. Conclusions: The VN technique in LSG significantly reduces liver enzyme elevation and the need for an extra trocar and incision, potentially lowering complication risk and enhancing patient outcomes.