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Can minilaparotomy abdominal aortic aneurysm repair be performed safely and effectively without special skills?
Kiyofumi Morishita1, Nobuyoshi Kawaharada, Jhoji Fukada
1Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuou-ku, Sapporo, Japan 060-8543.
Background:
The purpose of this study was to determine whether a surgeon without special skills can perform minimal incision abdominal aortic aneurysm repair as safely and effectively as traditional retroperitoneal aneurysmectomy.
Methods:
After informed consent, eligible patients were randomized into minilaparotomy and retroperitoneal groups. The minilaparotomy repair consisted of a short transabdominal midline incision, intraabdominal retraction of the bowel, control of back bleeding with balloon catheters, and hand-sewn anastomoses. The retroperitoneal approach was performed through a left vertical-lateral abdominal incision.
Results:
Twenty-six patients were randomly treated by minilaparotomy approach (n = 14) or retroperitoneal approach (n = 12) from December, 1999, to May 2001. Parameters for speed of recovery were indistinguishable and of no clinical significance. In the long-term follow-up (mean period, 27 months), no patients in the minilaparatomy group complained of discomfort from the incision, whereas 4 patients in the retroperitoneal group complained of discomfort (P < 0.05).
Conclusions:
Minilaparotomy approach can be performed safely and effectively without specialized skill. With regard to wound discomfort, the minilaparotomy technique is excellent. The minilaparotomy approach is therefore a useful alternative to traditional repair.