|Home | About | Journals | Submit | Contact Us | Français|
In laparoscopic surgery, views of the left upper quadrant may be impaired by omentum (Fig. 1). Access to the angle of His, which is crucial for both laparoscopic fundoplication and laparoscopic gastric banding, is difficult in the obese. We describe a technique to retract fat during laparoscopic procedures.
Using the most lateral port in the left upper quadrant, a 2-O nylon suture is used to pick up several bites of the greater omentum lying between the spleen and greater curve of the stomach (Fig. 2). The suture is then removed through the 11-mm port so that both ends are extracorporeal. The port is removed and replaced alongside the suture. Under direct vision, the suture is put under tension to retract the greater omental fat and clipped externally (Fig. 3). Access to the angle of His is thereby improved (Figs 4 and and55).
The senior author (MR) has used this method successfully for 15 years with no serious intra- or postoperative complications. One cautionary note is to ensure retraction is undertaken under direct vision to avoid tearing any adhesions to the spleen. The technique is a safe and simple method of fat retraction that can significantly improve surgical access to the angle of His during complex laparoscopic procedures.