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Hand-assisted laparoscopic aortobifemoral bypass versus open bypass for occlusive disease
John J Kelly1, Kent W Kercher, Karen A Gallagher
1Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Background:
Aortobifemoral bypass grafting is the treatment of choice for patients with symptomatic aortoiliac occlusive disease. Yet, traditional operative exposure through a midline laparotomy incision carries significant morbidity. The authors compare operative and patient outcomes following hand-assisted laparoscopic aortobifemoral (HALABF) bypass and open aortobifemoral (OABF) bypass.
Methods:
An initial series of patients who underwent HALABF bypass grafting (n = 8) were compared with a simultaneous cohort of patients treated with standard open bypass (n = 10). The two groups were similar with respect to age, weight, and sex. Operative parameters, clinical outcomes, and complications were compared.
Results:
HALABF was successfully performed in all eight cases attempted. Operative times did not differ between the laparoscopic and open groups (234 +/- 42 minutes vs. 206 +/- 43 minutes, P =.99). Mean blood loss values were comparable (562 mL [HALABF] vs. 756 mL [OABF], P =.56). There were no conversions. Time to resumption of oral intake (1.8 vs. 4.7 days, P =.001) and length of stay (3.8 vs. 6.3 days, P =.0004) were significantly shorter in the laparoscopic than in the open group.
Conclusions:
HALABF is a safe and technically feasible procedure. When compared with the traditional open operation, this technique may result in shorter hospitalization, more rapid return of bowel function, and earlier return to activity.