[Aorto-coronary bypass].
OBJECTIVE
Saphenous grafts used for coronary artery bypass are classically dissected via a continuous incision of the leg, the thigh or both. Recently, a new video-surgery technique has been introduced in an attempt to reduce the trauma of saphenous vein dissection. The aim of this work was to evaluate the possible benefits of this new technique compared with classical dissection.


METHODS
Sixty patients requiring coronary artery bypass grafts were included in this study and randomly divided into two groups. In group I (30 patients) the saphenous vein was dissected according to the classical technique. The video-surgery technique was used for the other 30 patients in group II. The two groups were not significantly different for mean age, sex ratio, or history of diabetes or lower limb arteriopathy. The same number of bypasses was performed in both groups (2.6 +/- 0.7). Outcome was compared for: dissection related complications (hematomas, infections), length of the skin incision over the length of the dissected vein, duration of the dissection procedure, and post-operative pain.


RESULTS
A leg incision was used in 28 cases out of 30 cases in both groups. The length of the saphenous vein dissected was 27.6 cm in group I and 21.8 cm in group II. The length of the skin incision was 27 cm in group I and only 4.7 cm in the video-surgery group II, giving an incision/vein ratio of 97% and 21% respectively. Operative time was however 37.9 min for group I and 48.5 min for group II. There was no significant difference between the groups for hematoma formation or infection but the patients in the video-surgery group experienced less post-operative pain.


CONCLUSIONS
Besides an improvement in the esthetic result, video-surgery dissection of the saphenous vein reduces post-operative pain at the cost of a slightly longer operative procedure.
Folliguet
T
T
Département médico-chirurgical cardiovasculaire, L'Institut Mutualiste Montsouris, Paris.
Le Bret
E
E
Moneta
A
A
Dibie
A
A
Temkine
J
J
Philippe
F
F
Dib
J C
JC
Laborde
F
F
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D012501:Saphenous Vein / Q000637:transplantation*; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014743:Videotape Recording / Q000379:methods*
Pontage aorto-coronarien.