[Dependence of surgical trauma in aortic interventions on the approach chosen. A prospective study]

Hand-assisted Laparoscopy Versus Conventional Median Laparotomy for Aortobifemoral Bypass for Severe Aorto-iliac Occlusive Disease: A Prospective Randomised Study

OBJECTIVES

To demonstrate that hand-assisted laparoscopy for aortofemoral bypass for severe aorto-iliac occlusive disease reduces morbidity with earlier recovery of bowel function and shorter in-hospital stay.

DESIGN

Randomised controlled trial.

MATERIALS AND METHODS

Thirty-six consecutive patients with severe aorto-iliac occlusive disease (TASK C/D) without history of major abdominal surgery necessitating an aortobifemoral bypass were randomised between a hand-assisted laparoscopic (HALS) approach and a conventional medial laparotomy. Operative data, early recovery data, quality of life and vascular outcome were analysed.

RESULTS

No significant differences in operative data were found. Fluid and solid diet were resumed earlier (28.8 hrs vs. 76.9 hrs; p = 0.016) (45.6 hrs vs. 105.6 hrs; p = 0.02) and in-hospital stay was shorter (7.5 vs. 8.9 days; p = 0.005) in the HALS group. Six weeks post-operatively social functioning measured by the SF-36 survey score was better in patients randomised to HALS (p=0.023).

CONCLUSIONS

HALS is a less invasive approach for aortofemoral bypass.

Hand-assisted Laparoscopic Aortobifemoral Bypass for Occlusive Disease. Early and Mid-term Results

OBJECTIVES

To evaluate the early and mid-term results of hand-assisted laparoscopic surgery (HALS) for aorto-iliac reconstruction.

DESIGN

Prospective survey.

MATERIALS AND METHODS

Between February 2002 and January 2004, 46 patients received an aortobifemoral bypass for advanced occlusive disease by HALS.

RESULT

There was one conversion to open surgery. Mortality was 4.5%. The median return to solid oral diet took 36 h (24-182), the median hospital stay was 5 days (3-26). Primary patency rate at 1 year was 97.5%. The incidence of incisional hernia was 19.5%.

CONCLUSIONS

HALS aorto-iliac reconstruction should be considered as a minimal invasive technique with good early and mid-term results.