To evaluate the clinical performance of two liver retraction techniques during laparoscopic hiatal hernia repair.

A total of 36 patients who underwent laparoscopic surgery for hiatal hernia in the Department of General Surgery, Qinghe County Central Hospital, Hebei Province, between December 2022 and December 2024 were retrospectively reviewed. Sixteen patients received liver retraction using an atraumatic grasper inserted via a subxiphoid port (grasper group), and 20 patients received liver retraction using a dedicated liver retractor inserted via a subxiphoid port (retractor group). A retrospective comparison was conducted to determine the effectiveness and safety of the two liver retraction methods in laparoscopic hiatal hernia repair.

All 36 patients successfully completed the procedure. There were no significant between-group differences in sex, age, or body mass index (P>0.05). The liver retractor setup time was significantly shorter in the grasper group than in the retractor group (P<0.05). Between-group comparisons showed no significant differences in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin levels preoperatively, on postoperative day 1, or before discharge (all P>0.05). Within-group comparisons indicated that ALT and AST levels on postoperative day 1 were significantly higher than preoperative levels in both groups (P<0.05), whereas total bilirubin on postoperative day 1 did not differ significantly from preoperative values (P>0.05). Before discharge, ALT and AST levels were significantly lower than those on postoperative day 1 (P<0.05), while total bilirubin before discharge did not differ significantly from postoperative day 1 (P>0.05). No significant differences were observed between preoperative values and those before discharge for ALT, AST, or total bilirubin (all P>0.05). There were no significant between- group differences in overall operative time or length of hospital stay (P>0.05). All patients were followed for at least 6 months after discharge, during which no recurrence, bleeding, or obstruction was observed in either group.

Compared with a dedicated liver retractor, liver retraction using an atraumatic grasper requires a shorter setup time, without a significant impact on total operative time. Both techniques appear safe and are not associated with severe or long-term liver injury.