Abstract
Objective: A minilaparotomy for the repair of infrarenal abdominal aortic aneurysm (AAA) may be less invasive than a full laparotomy for AAA repair. However, the minilaparotomy technique has not been widely performed because it requires special surgical instruments to obtain an adequate operative field. In our institution, minilaparotomies for AAA (wound length; 13±1 cm) are regularly performed. We retrospectively compared the outcomes of minilaparotomy AAA repair with those of full laparotomy AAA repair. Methods: From January 2006 to November 2009, 38 patients under 75 years old underwent elective AAA repair with bifurcated graft replacement. Of these, 17 (group M) underwent minilaparotomy, and 21 (group C) underwent full laparotomy. In group M, we exposed the proximal neck with the Kent retractor (Takasago Surgical Instruments, Tokyo), with the patient in the arched-back position. The occurrence of back flow from the iliac arteries was controlled with a tourniquet to expose the iliac arteries during distal anastomosis, and thus sufficient exposure for distal anastomosis was obtained even with a limited skin incision. We compared and analyzed the perioperative courses between the 2 groups. Results: The patient demographics did not significantly differ between the 2 groups, and there were no hospital deaths in either group. Furthermore, there was sgnificant difference seen in the ratios of suprarenal aortic clamping (group M; 41%, group C; 24%, P=0.25) or internal iliac reconstruction (group M; 35%, group C; 24%, P=0.44). However, operation time, the removal of the nasogastric tube, oral intake and ambulation were all significantly shorter in group M. Average hospital stay was shorter in group M than in group C. Conclusions: Minilaparotomy for AAA with commonly used surgical instruments may be superior to full laparotomy for AAA repair.
