Laparoscopic aortic surgery in obese patients.
BACKGROUND
Our objective was to demonstrate the feasibility of laparoscopic abdominal aortic aneurysm (AAA) repair in obese patients and to confirm advantages observed with laparoscopic techniques in other surgical specialties regarding pulmonary and parietal complications in this population.


METHODS
Between November 2000 and December 2007 we performed 37 laparoscopic aortic reconstructions in obese patients (body mass index [BMI] > 30 kg/m(2)). Median BMI was 31.9 kg/m(2) (range 30.1-40). Twenty-seven patients (73%) were operated for AAA and 10 (27%) for TASC C or D aortoiliac occlusive disease. Data were gathered prospectively and analyzed retrospectively.


RESULTS
Aortic exposure was totally laparoscopic in 36 patients (97.3%). Median operative time was 290 min (range 160-480). Median duration of clamping was 77.5 min (range 40-105). Orotracheal extubation was possible before H24 for 35 patients (95%). Median lengths of intensive care unit stay and hospital stay were, respectively, 48 hr (range 12-624) and 8 days (range 4-35). One patient (2.7%) died postoperatively because of colonic ischemia. Five systemic postoperative complications were observed in 36 patients who survived (13.5%) including major nonlethal postoperative complications in two patients (pneumopathy and acute hemodynamic lung edema). All other patients had a fast recovery, with minimal wound discomfort and rapid return to general diet and ambulation, with a median follow-up of 21.5 months (range 1-78). One patient was lost. Complete recovery was observed in 35 other patients, and all grafts were patent at last follow-up. No graft infection was observed, and none of our patients presented incisional hernia.


CONCLUSIONS
Obesity is not an operative risk factor for laparoscopic aortic surgery. Our results confirm its feasibility and durability for this high-risk population. Laparoscopy should be considered as the technique of choice whenever direct AAA repair is planned in obese patients.
Coscas
Raphaël
R
Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt, France.
Coggia
Marc
M
Di Centa
Isabelle
I
Javerliat
Isabelle
I
Cochennec
Frederic
F
Goëau-Brissonniere
Olivier
O
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D018579:Patient Selection; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome