Surgical Treatment of Patients With Lesions of the Aorto-iliac Segment Using Mini-laparatomic Access

Abstract

Introduction: Surgical treatment of patients with lesions of the aorto-iliac segment is one of the main problems of cardiovascular surgery. The problem of surgical treatment of patients with Leriche syndrome and abdominal aortic aneurysms has many unresolved issues and procedural complications. Aim of the study is to improve the results of surgical treatment for Leriche syndrome and infrarenal abdominal aortic aneurysms by applying mini-laparatomic access. Methods: 67 patients with infrarenal aortoiliac occlusion (TASC II C or D) and infrarenal abdominal aortic aneurysms were observed from January 2013 to October 2016. To perform an aorto-bifemoral bypass were compared the classic laparotomic access and mini-laparotomy. 32 (47.7%) patients underwent reconstructive surgery on the abdominal aorta using full laparotomy access, 35 (52.3%) patients contained mini-access. The parameters of access (wound depth, angle of operative action, angle of inclination) were determined using intraoperative and CT data. Patients were approached according to demographic data and cardiovascular risk factors. Surgery and anesthesia duration, bleeding volume were compared. In postoperative period severity of pain, duration of intestinal paresis, in-hospital length stay were measured. Results: Preoperatively estimated parameters allowed to perform the mobilization of infrarenal aorta, renal arteries, the Inferior mesenteric artery using mini-laparatomy access. Mean duration of mini-access surgery was 4:00 hours against 4:30 hours using traditional laparotomy access. Average blood loss was 236 ± 140.11 ml in mini-laparatomy groupe against 461 ml in classic laparatomy group. Besides, there was a significant decrease of drugs volume used during anesthesia in mini-access group. Postoperative intestinal paresis duration in mini-access group was 1.25 ± 0.053 days. Bowel paresis resolving in traditional access group was 2.15 ± 0.11 days. In-hospital stay length during postoperative period in mini-access group was 4-8 days against 10-12 days in classic laparatomy access group. Conclusion: Mini-laparatomy access has significant advantages over standard laparotomy access to the abdominal aorta, provides minimal damage during surgery, ease the postoperative period. Disclosure: Nothing to disclose