Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#4 PRELIMINARY EXPERIENCE WITH
MINI-LAPAROTOMY AORTIC SURGERY.
James D. Maloney, MD, John R. Hoch, MD, Sandy C. Carr, MD,
Charles W. Acher, MD, and William D. Turnipseed, MD
University of Wisconsin Hospitals and Clinics, Madison, WI
Objectives: This prospective non-randomized study was
undertaken to evaluate clinical outcomes of a mini-laparotomy
technique (MLT) used for elective graft repair of infrarenal aortic
aneurysm (AAA) and/or aortoiliac occlusive disease (AIOD).
Methods: Over an 8 month period, 23 patients requiring
infrarenal AAA or aortofemoral bypass for AIOD were treated using a
small periumbilical midline incision (<10 cm), non-displacement of
the small bowel, and a traditional handsewn vascular anastomosis not
requiring laparoscopic equipment. These were compared with
procedures performed in the standard transabdominal (STA) fashion
during the same time period (n=21). Age, weight, and comorbid
conditions were comparable between groups. Patients requiring
concomitant renal, mesenteric or infrainguinal revascularization were
excluded. Operating time, ICU stay, oral feeding times, and length
of hospital stay were recorded.
Results: Mean age of MLT group was 65 ± 10 yr, and 67
± 12 yr for STA. MLT patient weight ranged from 60-120 kg (mean
80 kg). Aneurysm size ranged from 4.0-8.2 cm (mean 5.5) and 4.2-9.0
cm (mean 6.0) for MLT and STA groups, respectively. OR time was 183
± 44 minutes for MLT and 191 ± 37 minutes for STA. Mean
ICU stay was 1 day for MLT compared to 1.8 days for STA (p=.03). One
MLT patient with significant COPD required prolonged ICU stay for
mechanical ventilation and diuresis due to pulmonary edema. Regular
diet was tolerated at 3.0 days after MLT and 4.7 days after STA
(p=.0036). Length of stay was 4.9 days with MLT compared to 7.25
days for STA (p=.0001). There was 1 postoperative death in the STA
group and no deaths in the MLT group.
Conclusion: Patients undergoing infrarenal aortic surgery
with MLT have improved pulmonary toilette, earlier ambulation, and
decreased postoperative ileus, leading to reduced ICU and hospital
stay. MLT does not increase OR cost, use expensive laparoscopic
equipment, or require extended postoperative radiographic
surveillance needed after endovascular repair for AAA and AIOD.
Last Updated 5/28/99