title: An alternative method of transperitoneal graft introduction in aortobifemoral bypass surgery.
abstract: BACKGROUND
  Intestinal injury and bleeding, which usually occurs while taking the graft through the transperitoneal tunnel, is one of the most important complications of aortobifemoral bypass surgery. In this study, case reports were examined where, for some reason, the tunneller instrument could not be used to create the transperitoneal tunnel and the tunnelling forceps was used. In some of these cases, the grafts were taken through conventionally and in others an alternative method was used.
  
  
  METHODS
  Between 2002 and 2013, the records of 81 patients treated surgically by aortobifemoral bypass for peripheral arterial disease, were investigated retrospectively. In the conventional method, after creating a tunnel with tunnelling forceps, the forceps was re-introduced into the tunnel and the graft was clasped and brought through the tunnel. In the alternative method, a nylon tape was left as a guide in the tunnel while creating the tunnel, and the forceps was not introduced again. The graft was taken through the tunnel with the help of the nylon tape. Patients treated with the conventional method were included in group 1 (n = 49) and patients in which the graft was guided with nylon tape were included in group 2 (n = 32). The groups were compared peri-operatively.
  
  
  RESULTS
  There were no significant differences between the groups in terms of co-morbidity factors. Extubation time, intensive care length of stay, revision for bleeding, other postoperative complications, and infection and late-term infection rates were similar in the two groups (p > 0.05). Hospital length of stay and blood usage were significantly higher in group 1 (p < 0.05). Drainage amounts were higher in group 1 but not statistically significant.
  
  
  CONCLUSIONS
  Using nylon tape to introduce the graft into the femoral area during aortobifemoral bypass operations was found to be more effective than using the tunnelling forceps.
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Beşir
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Gokalp
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Iner
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Ihsan
authors.initials: I
authors.lastname: Peker
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Yetkin
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Koksal
authors.initials: K
authors.lastname: Donmez
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Yilik
authors.affiliation: Ataturk Education and Research Hospital, Izmir Katip Çelebi University, Izmir, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Gurbuz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009757:Nylons; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D053832:Surgical Tape; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009757:Nylons