Proximal anastomosis in aortobifemoral bypass: end-to-end or end-to-side?

When performing an aortobifemoral bypass, the surgeon may choose between an end-to-end or end-to-side aortic anastomosis. Although several authors have claimed the superiority of the former, controversy still exists. The aim of this study was to compare the early and late results of these two techniques in patients for which both procedures were possible. Of 158 patients, aortic anastomosis was performed end-to-end in 47 (group I) and end-to-side in 111 (group II). Both groups were similar in all other aspects. The type of proximal anastomosis did not affect the rate of perioperative mortality or early thrombosis. There were no secondary aortic aneurysms or aortoenteric fistulae in either group. Actuarial primary (without reoperation) and secondary (after thrombectomy) five year patency rates were 90.2 and 98.9 per cent in group I, and 90.8 and 98.5 per cent in group II, respectively. Five-year limb survival was 95.3 and 95.7 per cent, respectively. As we could not find any difference between the results in the two groups, we suggest choosing the simplest procedure which maintains adequate pelvic and colonic blood supply, according to angiographic findings.

Femoropopliteal in situ saphenous vein bypass: technical aspects and factors determining patency.

The results and the factors influencing long-term patency rates in two technical variations of femoropopliteal "in situ" saphenous vein bypass procedures were evaluated retrospectively. Technique I (n = 33) consisted of a limited approach to the saphenous vein, destruction of the valves with a Cartier stripper and no tributary ligation. Technique II (n = 55) included complete exposure of the saphenous vein valvular destruction using Hall's stripper and ligation of all tributaries. Early thrombosis was observed in 21% and 3.6% of cases in techniques I and II, respectively. The frequency of local complications was identical in both techniques (18%). Overall actuarial primary patency at 4 years was 70%. Secondary patency (including patency following reoperations for graft failure) was 88% overall, 78.5% in technique I and 95% in technique II (p less than 0.05). The site of the distal anastomosis significantly influenced the four year cumulative patency rate (upper popliteal - 100%, lower popliteal - 93.6%, tibioperoneal vessels - 70.5%, p less than 0.05), whereas the number of patent leg vessels, the clinical stage of disease and the site of the proximal anastomosis (common femoral or superficial femoral artery) did not. Results obtained with the in situ saphenous vein bypass using technique II were better than with technique I. Close follow-up and preventive reoperations clearly enhanced patency rates. The site of distal anastomosis significantly affected long-term results.

[Rupture of third duodenum (author's transl)]. / Rupture complète de 3e doudénum. Intervention. Guérison.

The authors report a case of complete rupture of the third duodenum after blind trauma of the abdominal wall. They discuss pre op diagnosis with amount to X ray findings; surgical management included resection of the left part of the 3rd duodenum, 4th duodenum, and 1rst jejunal loop, with latero terminal anastomosis of the lower part of the 2nd duodenum to the jejunum; uneventfull recovery.

[Preoperative assessment: value and limitations in the preparation for surgery of esophageal or cardia carcinoma]. / Le bilan pré-opératoire; l'intérêt et les limites de la préparation a l'intervention d'un malade porteur d'un cancer de l'oesophage ou du cardia.

Pre-operative assessment of a patient suffering from a carcinoma of the oesophagus demonstrates numerous pathological features and marked malnutrition. The authors give details of their method of nutritional preparation: operation is scheduled only when the patients are restored to a state of anabolism, i.e. when daily potassium balance is greater than 40 mEq and daily nitrogen balance exceeds 4 g. Carolies are provided either intravenously or via a gastric tube. Alimentation consists on average of 2,000 to 2,6000 calories as carbohydrate and lipids and 12 to 14 g of nitrogen. This preparation lasts on average for one week. It is associated with a reduction in mortality and the number of postoperative complications.