Left sub costal minilaparotomy in aortic surgery.

Aim of this work is to present our surgical technique, i.e. a left sub costal transperitoneal minilaparotomy, used in 40 patients operated on in the last year for atherosclerotic aorto-iliac occlusive disease (aortofemoral bypass) and aortic or aorto-iliac aneurysm (aorto-aortic graft or aorto-iliac bifurcated graft sutured on the common iliac arteries). The patients are placed in a dorsal decubitus. The cutaneous incision of 10 to 15 cm, depending on the abdominal size, is parallel to the condro-costal edge and spreads from the linea alba to the edge of the rectus muscle. The linea alba is usually incised; the oblique and the transverse muscles are not touched. The bowel is maintained within the abdominal cavity. Usually we do not use self-retaining retractors. The abdominal wall and the bowel are retracted with moistened towels maintained by blade intestinal retractors. When the abdominal cavity is gained, conventional dissection of the aorta and iliac arteries is carried out. These manoeuvres and the following surgical procedure are performed as usually with standard vascular instruments. Nasogastric suction and drains are not used routinely. In our series, this minilaparotomy technique, joined to <>, and to an intensive postoperative training, allows a better outcome of the patient and a discharge home from 3rd to 5th postoperative day. So we think that this technique, not so expensive as endovascular repair or laparoscopic and video-assisted surgery, nevertheless retains all the proven benefits of a minimally invasive surgery.