Hand-assisted laparoscopic aortobifemoral bypass versus open bypass for occlusive disease

Aortobifemoral bypass grafting is the treatment of choice for patients with symptomatic aortoiliac occlusive disease. Yet, traditional operative exposure through a midline laparotomy incision carries significant morbidity. The authors compare operative and patient outcomes following hand-assisted laparoscopic aortobifemoral (HALABF) bypass and open aortobifemoral (OABF) bypass. An initial series of patients who underwent HALABF bypass grafting (n = 8) were compared with a simultaneous cohort of patients treated with standard open bypass (n = 10). The two groups were similar with respect to age, weight, and sex. Operative parameters, clinical outcomes, and complications were compared. HALABF was successfully performed in all eight cases attempted. Operative times did not differ between the laparoscopic and open groups (234 +/- 42 minutes vs. 206 +/- 43 minutes, P =.99). Mean blood loss values were comparable (562 mL [HALABF] vs. 756 mL [OABF], P =.56). There were no conversions. Time to resumption of oral intake (1.8 vs. 4.7 days, P =.001) and length of stay (3.8 vs. 6.3 days, P =.0004) were significantly shorter in the laparoscopic than in the open group. HALABF is a safe and technically feasible procedure. When compared with the traditional open operation, this technique may result in shorter hospitalization, more rapid return of bowel function, and earlier return to activity.