Minilaparotomy as Surgical Approach for Aortoiliac Occlusive Disease - Single Center Initial Experience
R.M. Neagoe, B. Voicu, D.T. Sala, A. Puskas, H. SuciuOriginal article, no. 5, 2013
Purpose: The purpose of this study was to emphasize thebenefits and indications of performing minilaparotomy assurgical approach for occlusive aortoiliac disease.Material and Method: From January 2011 to July 2012, a total of23 patients (19 men and 4 women), with a median age of 60years (range 49-75) diagnosed with aortoiliac occlusive disease(n=22) or abdominal aneurysm (n=1), were included in aretrospective non-randomized clinical study. Among thesepatients 11 underwent aortic bypass procedure by minilaparotomyapproach (ML group) and 12 patients by standard laparotomy(SL group). Demographic and clinical data, operative data, postoperative recovery data and complications wereanalysed according to these two groups of patients. Follow-upconsisted of clinical examination and duplex scanning at 1, 3,6 and 12 months postoperatively.Results: There were no significant differences between the minilaparotomyand standard laparotomy control groups concerningclinical and demographical data. Two surgical conversions tostandard laparotomy were necessary (18.18%) in the ML groupdue to technical difficulties. The mean operative time wasshorter in the ML group (124Â+-22 minutes) and the meanaortic clamping time was similar between the two groups.Major differences between the two lots were observed postoperatively;mean blood loss was more important in the SLgroup (550 ml) than in the ML group (350 ml) (statisticalsignificance p=0.001, Student test). Patients who haveundergone standard laparotomy required more fluids (10000 Â+-2000 ml) in comparison to the other group (6000Â+-1000 ml) â€"p value=0.0001, while the duration of nasogastric suction andperiod before resuming a liquid diet was both shorter in the MLgroup (1.1Â+-0.5 days) than those from the SL group (2.5Â+-0.6days) â€" p value=0.001. The period spent in the ICU wassignificantly shorter for the ML lot of patients and the medianhospitalization time was 5.6 days for patients in ML group,whereas in the SL group the median hospitalization time was8.9 days (Student test - p value 0.01). We had no 30-daymortality in any of the groups included in the study. Onepatient from the ML group was readmitted in postoperative day43 and re-operated on for a prosthetic limb graft thrombosis.Two patients were lost to follow-up and the mean follow-up was9Â+-1.5 months.Conclusions: Minilaparotomy as surgical approach for aorticdiseases is a feasible, safe procedure on selected patients.
