Early Experiences of Laparoscopic Aortofemoral Bypass in Korea-report from a Single Center.

Although endovascular approach can be widely applied to occlusive aortoiliac segment, aortofemoral bypass (AFB) continues to offer superior long term patency. In an effort to reduce the morbidity of AFB, LAFB (laparoscopic AFB) has been developed. We report our initial experiences to determine the feasibility and safety. From September 2005 to May 2008, LAFB was performed in 12 patients. A transabdominal retrocolic approach with pneumoperitoneum or direct approach was preferred. LAFB consisted of aortic dissection, vascular control with or without intracorporeal anastomosis. Last two cases were performed using da Vinci system for secure proximal anastomosis as an end to side fashion. Laparoscopic procedures were successfully performed in 11 patients. One patient underwent open conversion due to small bowel injury and bleeding. Mean operating time and aortic clamping time was 446 minutes and 87.5 minutes. The time to return of bowel function was about 2.1 days (2.1 ± 1.2). Compartment syndrome was developed in one patient at immediate postoperatively. During this study period, operating time was shown in decreasing tendency. Although LAFB is challenging procedure with steep learning curve, it is feasible technique and appears to ease patient's postoperative course.