Comparision of retroperitoneal and transperitoneal procedures in aortoiliac occlusive diseases

Comparision of transperitoneal [TP] and retroperitoneal procedures at the surgical treatment of aortiliac occlusive diseases [AIOD] was aimed in this study. Advantages and disadvantages of the procedures were also evaluated. From October 2003 to March 2009, 110 patients underwent aortic surgery. TP technique was performed to 50 patients and retroperitoneal[RP] technique was performed to 60 patients. Demographic datas, risk factors, peroperative and postoperative medical datas [24 parameters] were analyzed and compared between two groups. No statistically significiant difference was observed in demographic datas and risk factors. Five of eight operative parameters resulted in favor of RP procedure. Length of intensive care unit [ICU] stay [p<0.01] length of hospital stay [p<0.01], return of bowel functions [p<0.01], time of beginning oral feding [p<0.01], effort pain score [p<0.01] were significiantly different in RP group and, results were better than TP group. Pulmonary complications were analyzed as lesser in RP group [p=0.02] There was no statistically significant difference at the rest of complication datas [wound complications p=0.09, paralitic ileus p=0.14, re-operation p=0.46, 30 day mortality p=0.30]. Comparision of Medical datas showed that RP procedure is more advantegous than TP procedure at the surgical treatment of AIOD

Brachial plexus injury due to median sternotomy and lima harvesting

Brachial plexus injury is an unusual and under-recognised complication of coronary artery bypass grafting especially when internal mammary artery harvesting takes place. It is believed to be due to sternal retraction resulting in compression of the brachial plexus. Although the majority of cases are transient, there are cases where the injury is permanent and may have severe implications as illustrated in the accompanying case history. We investigated that injury to the brachial plexus was retrospectively assessed in the results of eight patients who underwent median sternotomy for open heart surgery. Between March 2006 and October 2008, 455 patients underwent cardiac surgery with median sternotomy. In post operative period peripheric neuropathy symptoms were observed in eight [1.7%] patients. All patients were placed in the hands up position after right internal jugular vein cannulation, and internal mammary artery was prepared for all those patients. The symptoms were classified as pain, sensory impairment and motor impairment. Brachial plexus injury was detected postoperatively in these eight patients. The patients with injured nerves were older and had undergone longer operation times. There were no differences between the patients with injured nerves and the others with respect to mammary artery harvesting or other operative variables. Full recovery occured in seven of eight [87%] patients after six monthes, one [13%] patient suffered from disesthesia. It is known that heart surgery sometimes causes partial brachial plexus injury, especially in the lower trunk. However, these peripheral nerve problems are usually not considered clinically important and are not investigated. Patients undergoing open heart surgery must be closely followed up for peripheral nerve injury during the postoperative period