Standard open repair versus minilaparotomy approach for abdominal aortic aneurysms: what is the best approach in patients with ischemic heart disease?

Abstract

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.

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.

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).

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.