Aim. To determine the optimal size and location of the mini-laparotomic access for the reconstruction of arteries of the aortofemoral segment. Methods. The method of mathematical modeling was used. The parameters of the mini-access were calculated depending on the sex of the patient, as well as for a variety of clinical situations (operations for occlusive disease, for abdominal aortic aneurysm, including the propagation of the aneurysmal dilatation to the iliac arteries). Topography of the aorta and iliac arteries was determined on the basis of computer tomograms of 155 patients (61 of them with an aneurysm of the infrarenal aorta). Results. It was established that for the purpose of creation of an adequate access an incision of 6.8-7.0 cm in length at the level of the umbilicus and above is sufficient during surgery for occlusive disease. No significant gender differences were found. During aortic aneurysm the required length of the mini-laparotomic access is significantly increased up to 7.6 cm (p=0.003), and in cases of propagation of the aneurysmal dilatation on to the common iliac arteries - up to 8.5 cm (p=0.001). In the latter case its location also changes: approximately half of the length of the access incision is located below the umbilicus. Conclusion. Mathematical modeling of the optimal mini-access makes it possible to optimize the use of mini-laparotomy in various clinical situations.
Aim. To compare invasiveness of reconstructive operations on arteries of aortofemoral segment using different accesses to surgical site. Methods. The analysis of the post-operative period was carried out in 40 patients who underwent aortofemoral bifurcation bypass surgery. Patients were assigned to 4 groups, each containing 10 patients. In group I surgeries were performed using mini-access of 5-7 cm, group II - mini-laparotomic access of 8-12 cm, group III - retroperitoneal mini-access, group IV - standard laparotomy. For invasiveness objectification, serum cortisol levels, forced lungs vital capacity and postoperative pain levels were measured. Results. All surgeries were performed as planned without inoperative complications. No deaths were registered. After mini-access surgeries intestinal peristalsis was defined by auscultation as soon as on 18-24 hour after the operation. Prolonged (more than 3 days) post-operative ileus was diagnosed in 3 patients, all operated using standard laparotomy. Serum cortisol level was typically elevated at the end of the surgery, but the difference was only statistically significant in patients from the group IV compared to baseline level as well as to patients with mini-access surgeries. Serum cortisol level reduced to normal at the second 24-hours after the surgery. Patients in which standard laparotomy was used reported more intense pain at the second day. Forced lungs vital capacity at day 4 was significantly reduced in patients of groups I, III and IV, with the significantly worse reduction in patients who overcame standard laparotomy compared to others. Conclusion. Mini-access reconstructive surgeries on aortofemoral segment arteries provide significant reduction of surgical trauma, which is proved by objective measurements.
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