Abstract
<title>Abstract</title> <p> <bold>Background</bold> Double-ligament fixation with left liver lobe suspension was evaluated for exposure in laparoscopic resection of upper gastric and adenocarcinoma of the esophagogastric junction (AEG). <bold>Methods</bold> Thirteen consecutive patients undergoing laparoscopic radical gastrectomy were retrospectively analyzed. The technique involves partial release of left triangular/coronary ligaments, fixation to the falciform ligament using a Hemolock clip, transabdominal round ligament suspension, and external fixation. <bold>Results</bold> The technique succeeded in all 13 (100%) with mean setup time 6.3±1.5 minutes. Two patients (15.4%) had minor puncture site bleeding (Clavien-Dindo I). No liver injury occurred. ALT showed elevation on day 1 (median 38.3 U/L, P=0.006) that persisted to day 7 (P=0.021). Among three cirrhotic patients (Child-Pugh A n=2; B with portal hypertension n=1), all had ALT elevation on day 1, with slower recovery in the Child-Pugh B patient. No 30-day major complications or mortality occurred. <bold>Conclusion</bold> This technique provides stable exposure with low complications, but is not recommended for Child-Pugh B/C cirrhosis. </p>