Reconstruction of the aortofemoral segment using a minilaparotomy access. Experience with 100 operations

This paper analyzes the results of 100 aortofemoral reconstructions using a miniaccess (patient group I), performed between July 2002 and December 2004. Of these, 92 reconstructions were bilateral and 8 unilateral. The patients' age ranged within 29-83 years (mean 58.3+/-0.9 years). The access to the aorta was gained through a median minilaparotomy (MLT) measuring 5-12 cm in length. The proximal anastomosis was formed above or at the level of the inferior mesenterial artery. The intra- and postoperative data were compared with the results of 162 aortofemoral reconstructions performed using a standard laparotomy (StLT) group II. The times of operation and aortic clamping did not increase during MLT (the time of operation was 192.3+/-4.0 and 207.7+/-5.1 min., the time of aortic clamping 24.3+/-1,6 and 25.8+/-1.7 min in groups I and II respectively). The lowering of traumatic injury during MLT resulted in a decrease of the amount of myorelaxants (by 17.1%; P<0.001) and of the volume of intraoperative infusion (by 12.4%; p<0.05). The short-term postoperative period in group I patients ran a milder course. The painful syndrome was less pronounced and bowel function returned to normal earlier. The incidence of local vascular complications was not different (9.0% during MLT and 10.5% during StLT). In group I, the incidence of local non-vascular complications decreased (from 14.8 to 8.0%, p=0.15) due to the absence of eventrations. The incidence of systemic complications during MLT dropped from 21.0% to 11.0% (p=0.056). During StLT the postoperative lethality accounted for 3.1%, that during MLT for 1.0% (p=0.49). The postoperative hospital stay decreased by 27.8% (p<0.001).