Die Abhängigkeit des Operationstraumas bei Aorteneingriffen von dem gewählten Zugang Eine prospektive Studie

Abstract

Transabdominal aortic replacement is the most widely accepted approach for aortic surgery. Several controlled studies report a more favorable outcome after an extraperitoneal incision, yet there are an equal number of papers with contradictory results. The aim of our study was to assess operative trauma after aortic surgery, depending on whether transperitoneal or extraperitoneal access was used. As a parameter for the extent of the surgical trauma the concentration of Interleukin 6 and acute phase proteins (CRP) was measured pre-, 6 h and 24 h after aortic surgery. One group consisted of 34 patients scheduled for aortic surgery for exclusion of an abdominal aortic aneurysm. The second group consisted of 26 patients who were operated on for aorto-iliac occlusive disease. Each group was subdivided into an equal group of patients operated on either extra- or transperitoneally. In the retroperitoneal aneurysm patients, a posterolateral access was favored, and in patients with occlusive disease an extraperitoneal anterolateral approach was chosen. As a result patients with an extraperitoneal incision and aorto-iliac occlusive disease required less postoperative respiratory support than those operated on transperitoneally. In this subgroup of patients there was a significantly reduced synthesis of Interleukin 6 and CRP. When a retroperitoneal posterolateral approach was required in aneurysm patients, there was no difference between groups. We conclude from our data that only patients with limited infrarenal aortic access can benefit, from the retroperitoneal incision in terms of a reduced immunological reaction.

Hand-assisted Laparoscopic Aortobifemoral Bypass for Occlusive Disease. Early and Mid-term Results

“…The operative morbidity of aorto-iliac reconstructions is mainly related to the surgical trauma derived from the extensive abdominal incision and dissection and not to the arterial reconstruction itself. 4,5 A possible strategy to reduce the morbidity of the procedure could be to minimize the access without changing the type of reconstruction itself. For this purpose a totally laparoscopic approach for aorto-iliac reconstructions has been developed.…”

Renal perfusion with venous blood extends the permissible suprarenal clamp time in abdominal aortic surgery

“…C-reactive protein seems to function as a marker for suprarenal clamp time, which has previously only been linked to other procedure-related details such as the operative approach. 39,40 It may be suggested, that dependent on preoperative computed tomography evaluation, patients with likely suprarenal clamp levels should optionally and with additional pre-existing renal impairment be facultatively scheduled for renal perfusion. An additional preoperative evaluation of the suitability of the renal arteries for perfusion may be helpful.…”

Hand-assisted Laparoscopy Versus Conventional Median Laparotomy for Aortobifemoral Bypass for Severe Aorto-iliac Occlusive Disease: A Prospective Randomised Study

“…2,3 However, it has been well documented that morbidity can be influenced by the surgical approach. 4,5 Therefore, in analogy with the good results of laparoscopic abdominal procedures, laparoscopic aortic surgery looks very promising. 6,7 But totally laparoscopic and even laparoscopically assisted aortic surgery remains technically demanding.…”