Crural stitch technique for liver retraction in laparoscopic upper gastrointestinal surgery: a retrospective case...

Effective liver retraction is essential for laparoscopic upper gastrointestinal (GI) surgeries. Traditional methods often require additional trocars, specialized instruments, and assistant support, which can increase procedural cost, operative time, and risk of liver trauma. This study presents a simple, cost-effective, and safe technique for liver retraction using a crural stitch without the need for additional incisions or equipment.

This retrospective single-surgeon, single-center case series included 1,956 patients who underwent various laparoscopic upper GI procedures at Nini Hospital, Lebanon, between 2011 and 2022. The liver retraction technique involved a 0-silk suture placed through the right anterior crura, exteriorized through a 2 mm incision using an ENDOCLOSE device, and secured externally with a clamp. Patient records were reviewed to assess the incidence of complications specifically related to the retraction method.

The technique was successfully used in all patients regardless of liver size or steatosis status. No complications, including hepatic injury or infection, were attributed to the liver retraction method across the spectrum of procedures, including sleeve gastrectomy, gastric bypass, hiatal hernia repair, myotomy for achalasia, and others.

The described crural stitch technique provides a safe, reproducible, and atraumatic alternative for liver retraction in laparoscopic upper GI surgeries. It eliminates the need for extra ports and instruments, reduces operating costs, and minimizes complications. Further prospective, multi-center studies are warranted to validate these findings and determine broader applicability.