Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

BACKGROUND: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. MATERIAL AND METHODS: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. CONCLUSIONS: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

Laparoscopic Assisted Management of a Pararectal Tail Gut Cyst.

Here, we discuss an unusual case of a pararectal tail gut cyst, initially misdiagnosed to be an ischiorectal abscess which was presented to us after being operated for incision and drainage. It was excised by a laparoscopic assisted approach. In such cases, a digital examination, transrectal ultrasound, CT scan, or MRI can help in the diagnosis. A combined approach is useful to locate and remove the cyst intact; however, a lower approach is useful for low-lying lesions. Histopathology can differentiate between a rectal duplication cyst and a tail gut cyst.