The “T-Suspension Tape” for Liver and Gallbladder Retraction in Bariatric Surgery: Feasibility,Technique,and Initial Experience

Abstract

Abstract

Background:

Safe and effective retraction of the liver is essential in providing adequate working space and a proper view of the stomach during laparoscopic bariatric surgery. Conventional liver retractors are expensive, require additional ports, resulting in pain and scarring, and cannot be utilized for single-port surgeries. To overcome these limitations we present a novel technique, using an indigenous “T-suspension tape,” for liver and gallbladder retraction.

Patients and Methods:

A retrospective analysis of the first 12 bariatric procedures using the “T-suspension tape” for liver retraction is presented here. The tape was created using the Teflon^® (Dupont, Wilmington, DE) tail of a Jackson–Pratt drain secured to a Prolene™ (Ethicon, Blue Ash, OH) suture on a long straight needle. The liver was retracted by transparenchymal passage of the needle, which was exteriorized and secured to the anterior abdominal wall.

Results:

There were 11 female patients and 1 male patient. The mean age was 30 years (range, 20–42 years), and the mean preoperative body mass index was 37.37 kg/m² (range, 33.14–48.98 kg/m²). There were six laparoscopic sleeve gastrectomies (including one single-incision procedure), two laparoscopic Roux-en-Y gastric bypasses, four laparoscopic adjustable gastric banded plications, and three concomitant cholecystectomies. Mean time for retraction was 4 minutes 33 seconds (range, 38 seconds to 20 minutes 20 seconds). The liver and also the gallbladder could be effectively retracted, providing excellent working space and visualization of the entire stomach. There were no complications or conversions associated with this technique.

Conclusions:

The “T-tape suspension” technique is simple, safe, and inexpensive and provides efficient retraction of the liver and gallbladder during bariatric surgery.