Central Surgical Association| Volume 128, ISSUE 4, P751-756, October 2000

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Less invasive aortic surgery: The minilaparotomy technique


      Background. This study evaluated a less invasive technique for exposure of the infrarenal aorta and its impact on the treatment of patients with abdominal aortic aneurysms (AAA) or aortoiliac occlusive disease (AIOD), or both. Methods. Forty patients with AAA (26), aneurysmal extension into the iliac arteries (6), or AIOD (8) were prospectively selected for minilaparotomy aortic exposure and repair using a small periumbilical midline incision (≤10 cm); intra-abdominal, nondisplaced retraction of the small bowel; and conventional hand-sewn vascular anastomoses. Perioperative comparisons with a contemporary group of AAA patients treated with long, open midline incision and extracavitary small bowel retraction were made. Results. There was no significant difference between the minilaparotomy and open surgical control groups for operating room time; intraoperative, perioperative morbidity; or mortality. Significant differences were documented between the minilaparotomy and the control group with regard to stay in the intensive care unit (days; 1.0 ± 1.2 versus 1.8 ± 1.5); return to general diet (days; 3 ± 1.3 versus 4.7 ± 2.8); and length of stay (days; 4.9 ± 1.8 versus 7.3 ± 3.4). Conclusions. Minilaparotomy exposure is safe and effective for treatment of infrarenal AAA and AIOD. This technique maintains quality outcome while reducing postoperative ileus, hospital stay, and resource utilization. (Surgery 2000;128:751-6.)
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