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Online ISSN 1827-1847
De Donato G., Weber G. *
From the ASL Napoli I Vascular Surgery Division San Giovanni Bosco Hospital II Naples University (Prof. G. de Donato)
* 1st Department of Surgery Medical University of Pécs, Hungary Division of Vascular Surgery (Chief: G. Weber, M.D., Ph.D)
Despite the angiosurgeon’s best efforts and the best possible postoperative care, the traditional aortobifemoral bypass procedure via the traditional transperitoneal approach that involves a large xipho-pubic or transversal incision is still burdened by a fairly high morbidity and mortality rate. For that reason and in order to minimise the surgical stress involved, a less invasive procedure has been developed that involves a minilaparotomy and a retroperitoneal approach to the aorta for the implantation of the aortobifemoral bypass. This MIDAS (Minimally Invasive Direct Aortic Surgery) technique was applied to 185 patients between October 1997 and March 2000. The MIDAS technique offers all the advantages of open surgery combined with the benefits to be derived from minimising tissue trauma. Access to the infrarenal aorta is retroperineal via a 5 cm median abdominal incision. This series produced 0% intraoperative mortality, while mortality in the immediate postoperative period came to 1.08% rising to 2.76% at 30 postoperative days. The first 152 MIDAS operations were compared to 150 aortofemoral bypasses involving conventional laparotomy (CL) and the following parameters were monitored: nasogastric drainage, intestinal peristalsis, start of feeding, pulmonary function, time in Intensive Care, length of hospital stay, surgery time and blood loss. MIDAS performed better under all those headings and its advantages may be summarised as: reduced trauma and pain, less damage to pulmonary function and fewer respiratory complications.
language: English, Italian