Mobilization of the Left Liver for Optimal Hiatal Exposure During Bariatric Surgery Procedures.

Abstract

Hepatomegaly, particularly an enlarged left liver lobe, is a well-recognized challenge in bariatric surgery, contributing significantly to staged procedures, conversions to open surgery, and aborted operations. Impaired intraoperative visualization hinders safe access to the hiatus and gastroesophageal junction, increasing the risk of complications. This report focuses on the laparoscopic mobilization of the left liver lobe as a reliable technique to address these challenges, offering improved exposure and facilitating precise surgical dissection. This technique should be considered a last resort to provide proper visualization of the hiatus when other retraction methods have failed. In our experience, this approach was applied in seven patients (six sleeve gastrectomies and one gastric bypass) with good outcomes. All patients tolerated the procedures well, and no intra- or post-operatively complications directly attributable to the mobilization technique were observed. These findings underscore the safety and efficacy of this method, making it a valuable tool for both primary and revisional bariatric surgeries.