Abstract
ABSTRACT - BACKGROUND:In the Roux-en-Y gastric bypass technique, classic laparoscopic surgical retractors are usually rigid, require an additional incision for its installation, or must be handled by an assistant during the surgical procedure, involving a risk of liver injury.Aim: The aim of this study was to evaluate and validate a technique of the esophagogastric junction exposure obtained by the flexible liver retractor in bariatric surgery, comparing its efficacy with the retractor classically used for this purpose.Methods: This study was performed as a randomized, open, prospective, controlled, and comparative design in patients with medical indications of bariatric surgery. The subjects were distributed in the classic (control) and flexible (test) retractor groups.Results: A total of 100 patients (n=50 control group, n=50 test group) were included. No statistically significant difference was observed in the mean duration of surgery. Regarding visibility, 100% of the patients in the flexible retractor group demonstrated an optimal visibility level, although without statistical significance concerning the classic retractor group (94%). Invariably, carrying a trocar was necessary when using the classic retractor.Conclusions: The flexible liver retractor is safe, effective, ergonomic, and inexpensive. Furthermore, it presented a satisfactory aesthetic profile, and the use of specific instruments, new adaptation curve, and training for its handling were not required.
Highlights
RETRACTOR IN BARIATRIC SURGERY: A RANDOMIZED CONTROLLED TRIAL Dvoaerisatthioendorof pvainricpeoarltcaal lpibreesrssuarnedatfhteer reesbolpehedaignoggraastteriscidnesvcahsicsutolasorimzaiatisoins iannldatsepfloenlloecwt-oumpy? influence the vRaoridartiigoonFoefitvoasraicdeealAclabluibqeuresrqauned LthimeareBbAleBeAdDinOgPrUatLeOsSin[1] s,cLhuiisztoGsoonmziaagsaisdine MlatOeUfoRlAlo-wJR-u1p,?Vagnaldo FECHINE2, MWaarlitnear BdeeckBeiarsSealSeIsLRVOAC-NHEAT2 O, 1Na, tCallaícuiadeAmNiTroUNQEUSI3RE, TShEo1m, aEzdAulaerxdaondGreuiCmOaSrTãAes[2] H, BorrunneoauAxlmdeeidMa OCOUSRTAA22, WMFaaablntreoicreidloOeFdBeoriarriesceioraSDICELO-VMAELO-HNROEAT3EOS,21Pa, uClloauHdEeRmMirAoNQ3UIRESE1, Eduardo Guimarães Horneaux de MOURA2, Fabricio Ferreira COELHO3, Paulo HERMAN3
Herman P. A queda da pressão portal após desvascularização esofagogástrica e esplenectomia influencia a variação do calibre das varizes e as taxas de ressangramento na esquistossomose no seguimento
Observou-se que o afastador flexível apresenta as condições técnicas para ser validado como instrumento de retração hepática para exposição adequada e segura da junção esofagogástrica em cirurgias bariátricas e em outros procedimentos de abdome superior em que o fígado dificulta a visibilidade
Summary
RETRACTOR IN BARIATRIC SURGERY: A RANDOMIZED CONTROLLED TRIAL Dvoaerisatthioendorof pvainricpeoarltcaal lpibreesrssuarnedatfhteer reesbolpehedaignoggraastteriscidnesvcahsicsutolasorimzaiatisoins iannldatsepfloenlloecwt-oumpy? influence the vRaoridartiigoonFoefitvoasraicdeealAclabluibqeuresrqauned LthimeareBbAleBeAdDinOgPrUatLeOsSin[1] s,cLhuiisztoGsoonmziaagsaisdine MlatOeUfoRlAlo-wJR-u1p,?Vagnaldo FECHINE2 , MWaarlitnear BdeeckBeiarsSealSeIsLRVOAC-NHEAT2 O, 1Na, tCallaícuiadeAmNiTroUNQEUSI3RE, TShEo1m, aEzdAulaerxdaondGreuiCmOaSrTãAes[2] H, BorrunneoauAxlmdeeidMa OCOUSRTAA22 ,, WMFaaablntreoicreidloOeFdBeoriarriesceioraSDICELO-VMAELO-HNROEAT3EOS,21Pa, uClloauHdEeRmMirAoNQ3UIRESE1 , Eduardo Guimarães Horneaux de MOURA2 , Fabricio Ferreira COELHO3 , Paulo HERMAN3. Figura 1 - Afastador flexível de fígado®composto por fio agulhado zero de seda de 60 cm enluvado por uma sonda de nelaton número 12, de 6-8 cm com, na qual cada paciente foi alocado em um dos dois grupos do estudo: controle ou teste.
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