[Clinical experiences with 43 cases of laparoscopic reconstruction in aortoiliac occlusive diseases: analysis of morbidity, effectiveness and treatment results].
Between October 1995 and April 2000 we performed 30 aortic laparoscopic reconstructions and 13 procedures on the iliac vessels. Severe aortic calcifications, poor cardiac and pulmonary status, and extensive intraabdominal adhesions were considered as contraindications for the laparoscopic procedure. Operative time, conversion rate, surgical and cardiopulmonary complications were recorded for an intention- to treat-analysis. Clinical criteria and Duplex ultrasound scans were used to document the patency of the grafts. The duration of analgetic therapy, nursing care, and hospital stay characterized the postoperative recovery. Mean surgical time was 302 minutes (min) in the aortic group (Ao) and 251 min in the iliac group (Ia). Seven conversions (5 in the aortic and 2 in the iliac group) occurred for clamping problems (n = 3), aortic lesion (n = 1), iliac vein lesion (n = 1), time consuming dissection (n = 1), and suturing failure (n = 1). Cardiac morbidity rate was 6.6% (Ao) and 7.7% (Ia). Two patients suffered pulmonary complications after aortic surgery (6.6%). Mean duration of analgetic therapy was 2.4 d (Ao) and 2.5 d (Ia). Nursing care was necessary for 4.4 d (Ao) and 3.1 d (Ia). At discharge the reconstructions were patent and ischemia symptoms subsided in all cases. Mean hospital stay was 9.1 d (Ao) and 6.7 d (Ia). At follow-up after a mean interval of 5.2 months (Ao) and 8.3 mo (Ia) patency was documented in all cases. Disease progression in the adjacent native vessels (n = 3) and beyond the graft (n = 1) was revealed by ultrasound scan, requiring a further vascular procedure. In our laparoscopic experience cardiac and pulmonary morbidity proved similar to traditional vascular surgery. The advantage of the minimally invasive approach seemed to be a more comfortable recovery. However, operative time and conversion rate emphasize the technical challenge of the procedure, which should be performed only in highly selected cases.
Abteilung für Gefässchirurgie, Klinik für Chirurgie der Ruhr-Universität Bochum am St. Josef-Hospital. letterio.barbera@ruhr-uni-bochum.de
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Barbera
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Geier
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Kemen
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Mumme
D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency