MDCT of retractor-related hepatic injury following laparoscopic surgery: Appearances, incidence, and follow-up

• Published in: Clinical radiology Vol. 69; no. 6; pp. 606 - 610
• Main Authors: Orr, K.E, Williams, M.P
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2014
• Subjects: Adult; Aged; Aged, 80 and over; Bariatric Surgery - adverse effects; Female; Follow-Up Studies; Gastrointestinal Neoplasms - surgery; Humans; Intraoperative Complications - diagnostic imaging; Intraoperative Complications - etiology; Laparoscopy - adverse effects; Liver - diagnostic imaging; Liver - injuries; Male; Middle Aged; Multidetector Computed Tomography; Radiology; Retrospective Studies; Young Adult
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2014.01.008

Aims To investigate the postoperative computed tomography (CT) features resulting from the use of Nathanson retractors during laparoscopic upper gastro-intestinal surgery. Materials and methods A 3-year retrospective study of 176 patients who had undergone laparoscopic upper gastro-intestinal surgery for bariatric or malignant disease was performed. Postoperative CT images [divided into early (≤30 days) and late (>30 days)] were assessed by a consultant radiologist and liver abnormalities recorded. Results The features of a retractor injury were a hypodense lesion, abutting the liver edge, usually triangular or linear in shape. Late postoperative features included focal subcapsular retraction and associated liver atrophy. Sixty-eight percent (52/77) of patients undergoing surgery for malignancy underwent postoperative CT, compared with 11% (11/99) of those undergoing bariatric surgery. Patients with malignancy were more likely to have retraction-related liver abnormalities (14/52, 27%) at postoperative CT than those in the bariatric group (2/11, 18%). Conclusion Retractor-related liver injuries at MDCT are common following laparoscopic upper gastro-intestinal surgery. Recognition of the characteristic triad of features, a hypodense lesion abutting the liver edge with a triangular or linear shape, should allow confident diagnosis. CT follow-up reveals that over time these lesions may disappear, remain unchanged, or result in a focal subcapsular scar with associated atrophy.