Laparoscopic versus Open Approach for Aortobifemoral Bypass for Severe Aorto-iliac Occlusive Disease - A Multicentre Randomised Controlled Trial

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• 作者：J. Tiek^a ; P. Remy^b ; T. Sabbe^a ; C. D&rsquo ; hont^b ; S. Houthoofd^a ; K. Daenens^a ; I. Fourneau^a ; ^{Inge.Fourneau@uzleuven.be}
• 关键词：Aorto-iliac occlusive disease ; Laparoscopy ; Aortobifemoral bypass
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2012
• 期刊代码：122_10785884
• 类别：med
• 出版时间：June, 2012
• 卷：43
• 期：6
• 页码：711-715
• 文件大小：300 K

摘要

Objectives

To investigate differences between open and laparoscopic aortobifemoral bypass surgery for aorto-iliac occlusive disease on postoperative morbidity and mortality.

Design

A multicentre randomised controlled trial.

Methods

Between January 2007 and November 2009, 28 patients with severe aorto-iliac occlusive disease (TASC II C or D) were randomised between laparoscopic and open approach at one community hospital and one university hospital (TASC = Trans-Atlantic Inter-Society Consensus on the Management of Peripheral Arterial Disease).

Results

The operation time was longer for the laparoscopic approach (mean 4聽h 19聽min (2聽h 00聽min to 6聽h 20聽min) vs. 3聽h 30聽min (1聽h 42聽min to 5聽h 11聽min); p聽=聽0.101)). Nevertheless, postoperative recovery and in-hospital stay were significantly shorter after laparoscopic surgery. Also oral intake could be restarted earlier (mean 20聽h 34聽min (6聽h 00聽min to 26聽h 55聽min) vs. 43 h 43聽min (19聽h 40聽min to 77聽h 30聽min); p聽=聽0.00014)) as well as postoperative mobilisation (walking) (mean 46聽h 15聽min (16聽h 07聽min to 112聽h 40聽min) vs. mean 94聽h 14聽min (66聽h 10聽min to 127聽h 23聽min); p聽=聽0.00016)). Length of hospitalisation was shorter (mean 5.5 days (2.5-15) vs. mean 13.0 days (7-45); p聽=聽0.0095)). Visual pain scores and visual discomfort scores were both lower after laparoscopic surgery. Also return to normal daily activities was achieved earlier. There were no major complications in both groups.

Conclusion

Laparoscopic aortobifemoral bypass surgery for aorto-iliac occlusive disease is a safe procedure with a significant decrease in postoperative morbidity and in-hospital stay and earlier recovery.