Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2024; 16(9): 2853-2859
Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.2853
Modified hepatic left lateral lobe inversion in laparoscopic proximal gastrectomy: An analysis of 13 cases
Jian-An Lin, Chu-Ying Wu, Kai Ye
Jian-An Lin, Chu-Ying Wu, Kai Ye, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Co-first authors: Jian-An Lin and Chu-Ying Wu.
Author contributions: Lin JA contributed to data curation, original draft preparation, project administration, and funding acquisition; Wu CY contributed to software, writing, review, and editing; Ye K contributed to conceptualization, supervision, and funding acquisition; all authors have read and agreed to the published version of the manuscript. Lin JA and Wu CY contributed equally to this work as co-first authors.
Supported by Key Clinical Specialty Discipline Construction Program of Fujian, Fujian Health Medicine and Politics, No. [2022] 884.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Fujian Medical University.
Informed consent statement: The requirement for informed consent was waived by the Ethics Committee considering the retrospective design of the study.
Conflict-of-interest statement: All authors report no conflicts of interest.
Data sharing statement: The datasets that were used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Ye, MD, Chief Doctor, Dean, Professor, Research Dean, Surgeon, Surgical Oncologist, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou 362000, Fujian Province, China. medwcy@163.com
Received: March 28, 2024
Revised: August 16, 2024
Accepted: August 21, 2024
Published online: September 27, 2024
Processing time: 173 Days and 13.4 Hours
Abstract
BACKGROUND

In laparoscopic proximal gastrectomy (LPG), the prolapse of the hepatic left lateral lobe near the lesser curvature and esophageal hiatus can obstruct the field of vision and operation. Therefore, it is necessary to retract or obstruct the hepatic left lateral lobe to ensure a clear field of vision.

AIM

To investigate the safety and clinical efficacy of the modified hepatic left lateral lobe inversion technique for LPG.

METHODS

A retrospective analysis was conducted on the clinical data of 13 consecutive patients with early-stage upper gastric adenocarcinoma or adenocarcinoma of the esophagogastric junction treated with LPG from January to December 2023 at the Department of Gastrointestinal Surgery, Second Affiliated Hospital of Fujian Medical University. The modified hepatic left lateral lobe inversion technique was used to expose the surgical field in all patients, and short-term outcomes were observed.

RESULTS

In all 13 patients, the modified hepatic left lateral lobe inversion technique was successful during surgery without the need for re-retraction or alteration of the liver traction method. There were no instances of esophageal hiatus occlusion, eliminating the need for forceps to assist in exposure. There was no occurrence of intraoperative hepatic hemorrhage, hepatic vein injury, or hepatic congestion. No postoperative digestive complications of Clavien-Dindo grade ≥ II occurred within 30 days after surgery, except for a single case of pulmonary infection. Some patients experienced increases in alanine aminotransferase and aspartate aminotransferase levels on the first day after surgery, which significantly decreased by the third day and returned to normal by the seventh day after surgery.

CONCLUSION

The modified hepatic left lateral lobe inversion technique has demonstrated satisfactory results, offering advantages in terms of facilitating surgical procedures, reducing surgical trauma, and protecting the liver.

Keywords: Hepatic left lateral lobe; Inversion technique; Laparoscopy; Proximal gastrectomy; Liver injury

Core Tip: This study retrospectively analyzed the clinicopathological data of patients who underwent laparoscopic proximal gastrectomy (LPG) with the modified hepatic left lateral lobe inversion technique. According to our research, the modified hepatic left lateral lobe inversion technique in LPG can facilitate surgical procedures, reduce surgical trauma, and protect the liver.