Reconstruction of the aortofemoral segment using a minilaparotomy access. Experience with 100 operations.

This paper analyzes the results of 100 aortofemoral reconstructions using a miniaccess (patient group I), performed between July 2002 and December 2004. Of these, 92 reconstructions were bilateral and 8 unilateral. The patients' age ranged within 29-83 years (mean 58.3+/-0.9 years). The access to the aorta was gained through a median minilaparotomy (MLT) measuring 5-12 cm in length. The proximal anastomosis was formed above or at the level of the inferior mesenterial artery. The intra- and postoperative data were compared with the results of 162 aortofemoral reconstructions performed using a standard laparotomy (StLT) group II. The times of operation and aortic clamping did not increase during MLT (the time of operation was 192.3+/-4.0 and 207.7+/-5.1 min., the time of aortic clamping 24.3+/-1,6 and 25.8+/-1.7 min in groups I and II respectively). The lowering of traumatic injury during MLT resulted in a decrease of the amount of myorelaxants (by 17.1%; P<0.001) and of the volume of intraoperative infusion (by 12.4%; p<0.05). The short-term postoperative period in group I patients ran a milder course. The painful syndrome was less pronounced and bowel function returned to normal earlier. The incidence of local vascular complications was not different (9.0% during MLT and 10.5% during StLT). In group I, the incidence of local non-vascular complications decreased (from 14.8 to 8.0%, p=0.15) due to the absence of eventrations. The incidence of systemic complications during MLT dropped from 21.0% to 11.0% (p=0.056). During StLT the postoperative lethality accounted for 3.1%, that during MLT for 1.0% (p=0.49). The postoperative hospital stay decreased by 27.8% (p<0.001).

[Substantiation of the extent of surgery in varicose veins of the lower extremities]. / Obosnovanie ob''ema operatsii pri varikoznoi bolezni nizhnikh konechnostei.

The authors have distinguished 2 forms of the varicose disease of lower extremities determining the volume of surgical operation. Since the "simple" form is characterized only by incompetent valves of the superficial veins, the radical veinectomy is thought to be a sufficient operation and gives a complete recovery of the adequate venous return. In patients with the 2nd form of the varicose disease the radical veinectomy only is not the optimal operative intervention. Ligation of incompetent perforated crus veins by super- or subfascial methods is indicated to such patients.