Totally laparoscopic aortobifemoral bypass surgery in the treatment of aortoiliac occlusive disease or abdominal aortic aneurysms – a systematic review and critical appraisal of literature

Abstract

Purpose: This systematic review aims to evaluate the published literature regarding totally laparoscopic aortobifemoral bypass (LABF) surgery in the treatment of aortoiliac occlusive disease (AIOD) or abdominal aortic aneurysms (AAA), compared with open aortobifemoral bypass surgery. Materials and methods: A systematic review of the medical literature between 1990 and 2016 was performed, searching the medical databases Cochrane Library, OVID Medline, Embase and PubMed. Studies concerning totally LABF with or without control group and containing more than 10 patients were included in the analysis. Operative and aortic cross-clamping times, blood loss, rate of conversion to open surgery, mortality and morbidity within the first 30 postoperative days, hospital stay and primary and secondary patency of the graft were extracted and compared with open surgery when possible. Results: Sixty-six studies were deemed eligible for inclusion in this review, 16 of them matched the inclusion criteria for quantitative synthesis. The patient material consisted of 588 patients undergoing totally LABF, 22 due to AAA, and the remaining 566 for AIOD. Five comparative studies regarding AIOD compared 211 totally LABF procedures with 246 open procedures. Only one study concerning AAA was eligible for inclusion, and this study did not provide a comparison against an open group. The operating and aortic cross-clamping times were shorter in the open group. Conversion rates ranged from 0% to 27%. There was no statistically significant difference in mortality between the two groups (p=0.64). Hospital stays ranged from 4.0 to 12.1 and 5.0 to 12.8 days in the laparoscopic group and open group, respectively. Most of the studies provided low levels of evidence, mainly due to lack of blinding, randomization and correction of bias. Conclusion: Totally laparoscopic aortoiliac surgery seems to be a feasible technique with unaffected mortality and trend toward benefits in hospital stay and possibly also in complication rates. The literature published this far is sparse and with inconsistent results. More randomized controlled trials are required before this method can be widely implemented.

Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

“…Some have argued the lack of “hard data”, like morbidity and mortality, in these cost-utility evaluations and have also uttered concerns about the use of QALYs and its role in decision making 22,39,40. However, there are no known differences in morbidity or mortality between LABF and OABF for AIOD to this day 9,11. Hence, a cost-utility is an appropriate tool for comparing two procedures, combining the patient-reported quality of life with an economic perspective.…”

“… 22 , 39 , 40 However, there are no known differences in morbidity or mortality between LABF and OABF for AIOD to this day. 9 , 11 Hence, a cost-utility is an appropriate tool for comparing two procedures, combining the patient-reported quality of life with an economic perspective.…”

“…The implementation of laparoscopic aortic surgery, has been slow. 11 However, gradually there has been published evidence that the LABF combines the benefits of a minimally invasive technique with the excellent long-term patency rates of OABF for the treatment of AIOD. 7 , 13 In the present study, we have demonstrated higher postoperative HRQoL combined with lower costs after LABF compared with OABF.…”

“…In patients with aortoiliac occlusive disease (AIOD), which is a manifestation of PAD, blood flow to the lower extremities can be improved with the help of either a totally laparoscopic or an open aortobifemoral bypass. The laparoscopic aortobifemoral bypass (LABF) has become an established treatment option for symptomatic AIOD at many dedicated centers 6–11. At Oslo University Hospital, we introduced the laparoscopic technique in 2005,12–14 and since February 2013, we have been conducting a randomized controlled trial,15,16 to compare the early morbidity after the two treatment methods.…”

Comparison of transperitoneal and retroperitoneal approach for aortoiliac artery occlusive disease

“…[2][3][4] In recent years, laparoscopic aortobifemoral bypass grafting has been used in the management of aortofemoral artery occlusive disease as a minimally invasive surgical approach, although there is still no study directly comparing laparoscopic aortobifemoral bypass with endovascular treatment for extensive aortoiliac occlusive disease. [5,6] In the present study, we aimed to compare retroperitoneal and transperitoneal approaches in aortoiliac occlusive diseases and to evaluate the advantages and disadvantages of each technique.…”