Less invasive aortic surgery: The minilaparotomy technique

Background, This study evaluated a less invasive technique for exposure of the infrarenal aorta and its impact on the treatment of patients with abdom inal aortic aneurysms (AAA) or aortoiliac occlusive disease (AIOD), or both . Methods. Forty patients with AAA (26), aneurysmal extension into the iliac arteries (6), or AIOD (8) were prospectively selected for minilaporotomy ao rtic exposure and repair using a small periumbilical midline incision (less than or equal to 10 cm); intra-abdominal, nondisplaced retraction of the s mall bowel; and conventional hand-sewn vascular anastomoses. Perioperative comparisons with a contemporary group of AAA patients treated with long, op en midline incision and extracavitary small bowed retraction were made. Results. There was no significant difference between the minilaparotomy and open surgical control groups for operating roam time intraoperative, perio perative morbidity; or mortality. Significant differences were documented b etween the minilaparotomy and the control group with regard to stay in the intensive care unit (days; 1.0 +/- 1.2 versus 1.8 +/- 1.5); return to gener al diet (days; 3 +/- 1.3 versus 4.7 +/- 2.8); and length of stay (days; 4.9 +/- 1.8 versus 7.3 +/- 3.4). Conclusions. Minilaparotomy exposure is safe and effective for treatment of infrarenal AAA and AIOD. This technique maintains quality outcome while re ducing postoperative ileus, hospital stay, and resource utilization.