title: Total laparoscopic bypass is safe and effective for aortoiliac occlusive disease.
abstract: OBJECTIVE
  We reviewed our experience of total laparoscopic aortic bypass surgery performed for aortoiliac occlusive disease (AIOD), focusing on early 30-day mortality and morbidity and short-term and midterm outcomes.
  
  
  METHODS
  A monocentric retrospective study was conducted between October 2002 and October 2011; we performed 173 total laparoscopic aortic surgeries to treat AIOD.
  
  
  RESULTS
  Patients included 135 men and 38 women. The mean age was 57.2 years (range, 34-77 years). The median operative time was 205 minutes (range, 120-420 minutes), the median aortic clamping time was 50 minutes (range, 20-120 minutes), and the mean blood loss was 263 mL (range, 0-3200 mL). Conversion to open surgery was necessary in 12.1% of patients. The 30-day postoperative mortality rate was 2.3% (four of 173 patients). Major morbidity occurred in 6.9% of patients. Wound complications occurred in 8%. Four patients had a groin infection (2.3%), treated by surgical trimming in three patients and replacement of the prosthesis by venous bypass in one patient. Early graft thrombosis (within 30 days) occurred in one patient (0.6%), requiring reintervention. With a mean follow-up of 42 months (standard deviation, 37 months), 96% of bypasses were patent. Patency rates at 3 and 5 years were 97% and 85% respectively.
  
  
  CONCLUSIONS
  In selected patients, laparoscopic aortic bypass surgery for AIOD is a safe procedure with an acceptable morbidity rate, short intensive care unit and hospital stay, fast recovery, and early return to general diet. It is a good indication after failure of endovascular surgery.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hôpital Saint-Joseph, Gilly, Hainaut, Belgium. Electronic address: kaoutar.ghammad@hotmail.com.
authors.forename: Kaoutar
authors.initials: K
authors.lastname: Ghammad
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hôpital Saint-Joseph, Gilly, Hainaut, Belgium.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dupuis
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hôpital Saint-Joseph, Gilly, Hainaut, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Amond
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hôpital Saint-Joseph, Gilly, Hainaut, Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: D'Hont
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hôpital Saint-Joseph, Gilly, Hainaut, Belgium.
authors.forename: Edo
authors.initials: E
authors.lastname: Wijtenburg
authors.affiliation: General Practitioner, Hôpital Saint Joseph, Gilly, Hainaut, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Piette
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hôpital Saint-Joseph, Gilly, Hainaut, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Remy
mesh_terms: D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001530:Belgium; D016063:Blood Loss, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency