The effect and clinical significance of using nathanson liver retractor on liver function tests in laparoscopic gastric cancer surgery

Aim: There are very few studies in the literature investigating the changes caused by the Nathanson retractors in liver function tests (LFT) after LG and their clinical significance. The present study investigated the changes made by the Nathanson retractor used during laparoscopic gastrectomy (LG) in LFT and their clinical significance. Material and methods: The data of 236 patients who underwent radical gastrectomy for primary gastric cancer at Surgical Oncology Unit in the period between January 2015 and January 2020 were retrospectively studied. The patients were divided into two groups: laparoscopic gastrectomy (LG; 136 cases) and open gastrectomy (OG; 106 cases). Patients after cholecystectomy, with primary or secondary liver tumors, with chronic hepatic disease, with high preoperative ALT, AST and bilirubin values were excluded from the study. LFT were measured preoperatively and on postoperative day 1 (LFT1), LFT3, LFT5 and LFT7. LFT: ALT, AST and Total bilirubin (BIL). Results: ALT1, ALT3, ALT5, ALT7 ALT values and AST1, AST3, AST5 AST values of patients in the LG group were found to be significantly higher (P < 0.001). Mean total bilirubin values of the groups were similar (P > 0.05). In order to evaluate how the increase in LFT due to the use of the Nathanson retractors reflected on the patients' clinic, we divided the patients who underwent LG into two groups based on ALT increase in ALT1: Normal and Elevated. The in-hospital mortality rates (P= 0.080) and oral nutrition time (P = 0.913) of the groups were similar. No liver infarction developed in any of the groups. The duration of stay in the ICU was significantly longer in individuals with elevated LFT (P= 0.019). Conclusion: Although the use of the Nathanson retractor during LG causes an increase in liver function test results, this does not cause major clinical problems in patients.