| Standard open repair versus minilaparotomy approach for abdominal aortic aneurysms: what is the best approach in patients with ischemic heart disease? | |
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MedLine Citation:
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PMID: 18607322 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: The beneficial effects of minilaparotomy approach in patients undergoing abdominal aortic aneurysm (AAA) repair have been defined. In this respect, the authors compared treatment outcome and procedure-related mortality rates of minilaparotomy technique with those of open standard repair in patients with ischemic heart disease. METHODS: The authors retrospectively reviewed data on 212 patients who underwent elective AAA repair via a minilaparotomy approach at the Hospital of Istanbul over an 8-year period from February 1995 to January 2003. The clinical study included 46 patients who have only ischemic heart disease as a sole risk factor. This group was matched in a case-control fashion to a group of 57 patients with similar characteristics who were operated via standard median laparotomy. All available clinical, pathologic and postoperative data were reviewed and analyzed for postoperative outcome. RESULTS: Mean operative times in mini- and standard laparotomy groups were 190+/-26 min and 165+/-15 min, respectively (P=0.32). Aortic clamping times did not differ significantly between two groups (61+/-12 min vs 53+/-10 min, P=0.43). Blood requirement was lower in minilaparotomy group. Five patients (8.7%) in the standard median laparatomy group died, while one death (2%) occurred in the other group (P<0.01). In patients who have undergone traditional repair, 5 patients suffered from myocardial infarction and 4 patients required prolonged mechanical ventilation. No coronary ischemic event was noticed in minilaparotomy patients. The minilaparotomy group had significantly shorter lengths of hospital (6.2+/-1.1 vs 9.3+/-2.8 days, P=0.03) and intensive care unit (ICU) stays (7.8+/-2.3 vs 14.5+/-3.2 hours, P=0.01). Duration of adynamic ileus (1.9+/-0.6 vs 2.8+/-1.1 days, P=0.02), return to normal diet (3.2+/-1.0 vs 4.6+/-1.3 days, P=0.01) and day of ambulation (1.5+/-0.3 vs 3.2+/-0.7 days, P=0.001) were significantly lower in the minilaparotomy group. The standard median laparotomy group was twice as costly as the minilaparotomy group (3 200+/-600 vs 5 900+/-900 US dollars, P=0.001). CONCLUSION: The minilaparotomy technique has advantages that include less postoperative morbidity and mortality rates, early resumption of intestinal functions, reduced cost, decreased length of stay in the ICU and hospital. There-fore, the authors believe that this approach is still a valid alternative approach in the treatment of patients with AAA having ischemic heart disease as a risk factor. |
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Authors:
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Y Kalko; M Ugurlucan; M Basaran; E Nargileci; U Kafa; T Kosker; C Yerebakan; T Yasar |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Minerva chirurgica Volume: 63 ISSN: 0026-4733 ISO Abbreviation: Minerva Chir Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-07-08 Completed Date: 2009-02-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0400726 Medline TA: Minerva Chir Country: Italy |
Other Details:
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Languages: eng Pagination: 269-76 Citation Subset: IM |
Affiliation:
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Cardiovascular Surgery Service, Bezm-I Alem Vakif Gureba Hospital, Istanbul, Turkey. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aortic Aneurysm, Abdominal / complications*, surgery* Case-Control Studies Female Humans Laparotomy* / methods Male Myocardial Ischemia / complications* Retrospective Studies Vascular Surgical Procedures / methods |
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