Laparotomía transversa versus laparotomía media en cirugía de aorta abdominal infrarrenalResultados iniciales

Résumé

INTRODUCTION. Midline laparotomy is the most extended abdominal approach, although in the English medical literature reviewed, the transverse incision is associated with less postoperative pain, less respiratory impairment, and earlier oral tolerance. Despite of published reports it represents a controversial subject and the ultimate choice depends on the surgeon preference. AIM. To compare results between transverse and midline laparotomy in scheduled infrarrenal abdominal aortic surgery. MATERIAL AND METHODS. Clinical, prospective trial on going, between October 2006 and February 2008, made up of the first 20 patients with atherosclerotic pathology (8 cases) and abdominal aortic aneurismatic disease (12 cases), undergone to scheduled operation, randomized in two groups (9 transverse and 11 midline). The mean age was 69 years old. The mean follow-up period was 8 months. Retroperitoneal approaches were excluded. Several endpoints are: postoperative pain, pulmonary function, beginning of the oral tolerance and total tolerance. For the statistical analysis, SPSS 13.0 was used. RESULTS. No significant differences were found related to vascular risk factors between groups, postoperative pain or postoperative pulmonary function, although there is a favourable trend in the transverse group related to the primary endpoints. CONCLUSIONS. Although transverse laparotomy is less extended, in our study; it seems to offer better results in terms of postoperative pain, pulmonary function impairment and oral tolerance recovery. These results pump us up to go on with the aim of confirm these data, although the ultimate decision depends on the surgeon preference.