RESUMEN
BACKGROUND: Totally laparoscopic aortobifemoral bypass (LABF) procedure has been shown to be feasible for the treatment of advanced aortoiliac occlusive disease (AIOD). This study compares the LABF with the open aortobifemoral bypass (OABF) operation. METHODS: In this prospective comparative cohort study, 50 consecutive patients with type D atherosclerotic lesions in the aortoiliac segment were treated with an LABF operation. The group was compared with 30 patients who were operated on with the OABF procedure for the same disease and time period. We had an explanatory strategy, and our research hypothesis was to compare the two surgical procedures based on a composite event (all-cause mortality, graft occlusion, and systemic morbidity). Stratification analysis was performed by using the Mantel-Haenszel method with the patient-time model. Cox multivariate regression method was used to adjust for confounding effect after considering the proportional hazard assumption. Cox proportional cause-specific hazard regression model was used for competing risk endpoint. RESULTS: There was a higher frequency of comorbidity in the OABF group. A significant reduction of composite event, 82% (hazard ratio 0.18; 95% CI 0.08-0.42, P=0.0001) was found in the LABF group when compared with OABF group, during a median follow-up time period of 4.12 years (range from 1 day to 9.32 years). In addition, less operative bleeding and shorter length of hospital stay were observed in the LABF group when compared with the OABF group. All components of the composite event showed the same positive effect in favor of LABF procedure. CONCLUSION: LABF for the treatment of AIOD, Trans-Atlantic Inter-Society Consensus II type D lesions, seems to result in a less composite event when compared with the OABF procedure. To conclude, our results need to be replicated by a randomized clinical trial.
Asunto(s)
Enfermedades de la Aorta/cirugía , Aterosclerosis/cirugía , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Laparoscopía , Injerto Vascular/métodos , Anciano , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/mortalidad , Aterosclerosis/diagnóstico , Aterosclerosis/mortalidad , Pérdida de Sangre Quirúrgica , Supervivencia sin Enfermedad , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/mortalidad , Tiempo de Internación , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Placa Aterosclerótica , Complicaciones Posoperatorias/etiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Injerto Vascular/efectos adversos , Injerto Vascular/mortalidadRESUMEN
BACKGROUND: Laparoscopic aortic surgery (LAS), performed since 1993, has undergone a number of technical improvements during recent years. The published results are comparable with those for open surgery. The aim of this article is to present the method with a focus on technical details, and at the same time present our experience with this technique. MATERIAL AND METHODS: Eight patients with debilitating intermittent claudication were operated with a total laparoscopic aortofemoral bypass. Operations were performed through a transperitoneal retrorenal approach. Median age of the patients was 61 years (range 51-76). All patients had an aortoiliac occlusive disease of type D according to the Transatlantic Inter Society Consensus (TASC). Prior to the procedures an operation team followed a structured training programme that comprised using a training model and operating on pigs, and visited an international referral centre. RESULTS AND INTERPRETATION: All operations were successfully performed. No patient developed per- or post-operative complications. Median post-operative hospital stay was four days. LAS is a technically demanding procedure and it can be established through well targeted and carefully planned training.