Minimally invasive technologies in reconstructive surgery of abdominal aortic aneurysms

Aim: to evaluate the immediate results of the treatment of uncomplicated infrarenal aortic aneurysms using minilaparotomic access in patients with a body mass index of up to 35 kg/m² and using preliminary videolaparoscopic dissection of the aortic aneurysm neck in patients with a body mass index of 35 kg/m² or more.

Materials and methods: а retrospective analysis of surgical treatment of patients with infrarenal aortic aneurysms was performed. The main group No. 1 (MG 1) consisted of 454 patients with a body mass index (BMI) of less than 35 kg/m², whose operation began using a median minilaparotomy in the mesogastric 5-7 cm long. The main group No. 2 (MG 2) consisted of 22 patients with a BMI from 35 kg/m² to 40 kg/m², who underwent video laparoscopic dissection of the aortic aneurysm neck at the first stage, then the operation was performed from a minilaparotomy access or a transition to a complete median laparotomy (conversion). The control groups (CG 1 and CG 2) corresponding to their main criteria were patients who were operated on from a complete median laparotomy.

Results: in patients with MG 1, conversion was undertaken in 164 (36%) cases. In patients with MG 2, conversion was necessary in 10 (45.5%) cases. The reasons for the transition to full median laparotomy in both groups were a combination of various factors. The cross-group comparative analysis was carried out without taking into account patients who required conversion. In groups MG 1 - CG 1 and MG 2 - CG2 (hereinafter, respectively), the duration of the operation was 140±30 min - 150±30 min and 210±40 -180±30 min. Patients were extubated in the operating room in 249 (85,8%) - 50 (41,7%) and 8(66,7%) - 45(31,7%) in some cases; the motor evacuation function of the intestine was restored on 2 ±1 - 3 ± 1 and 3± 1 - 4 ± 1 days; patients were activated within the ward for 2±1 - 3±1 and 2±1 - 4±1 days; the duration of postoperative inpatient treatment was 7±2 - 11±3 and 8±2 - 2±3 days; subcutaneous eventration of the omentum or small intestine was noted in 4 (1.4%) - 6(5%) and 0% - 7 (4.9%) cases; postoperative pneumonia developed in 10 (3,4%) - 13 (10,8%) and 1 (8,3%) - 20 (14,1%) patients; acute cardiac complications have been reported in 9 (3,1%) - 9 (7,5%) and 0% - 12 (8.5%) cases; postoperative mortality was 4 (1,4%) - 6(5%) and 0% - 7 (4.9%).

Conclusion: in the surgical treatment of patients with aneurysms of the infrarenal aorta, in order to reduce the risk of postoperative complications, a minilaparotomy approach can be successfully applied. The use of video laparoscopic technologies makes it possible to expand the possibilities of performing operations from a mini-access.

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