Vascular Health and Risk Management (Mar 2020)
A Short Series of Laparoscopic Mesenteric Bypasses for Chronic Mesenteric Ischemia
Abstract
Syed Sajid Hussain Kazmi,1,2 Simen Tveten Berge,1,2 Mehdi Sahba,2,3 Asle Wilhelm Medhus,4 Jon Otto Sundhagen1 1Department of Vascular Surgery, Heart, Lung and Vascular Clinic, Oslo University Hospital Aker, Oslo, Norway; 2Faculty of Medicine, University of Oslo, Oslo, Norway; 3Department of Vascular Surgery, Ostfold Central Hospital, Kalnes, Norway; 4Department of Gastroenterology, Oslo University Hospital, Ullevål, NorwayCorrespondence: Syed Sajid Hussain KazmiDepartment of Vascular Surgery, Heart, Lung and Vascular Clinic, Oslo University Hospital Aker, Oslo, NorwayEmail [email protected]: Laparoscopic aortomesenteric bypass may be performed to treat the chronic mesenteric ischemia patients who are not suitable for endovascular treatment. This study presents an initial experience with a limited series of laparoscopic mesenteric artery revascularization for the treatment of mesenteric ischemia.Methods: Chronic mesenteric ischemia (CMI) patients with previous unsuccessful endovascular treatment or with arterial occlusion and extensive calcification precluding safe endovascular treatment were offered laparoscopic mesenteric revascularization. From October 2015 until November 2018, nine patients with CMI underwent laparoscopic revascularization. In addition to demographic data and perioperative results of the treatment, graft patency was assessed with Duplex ultrasound at 1, 3, 6 and 12 months, and annually thereafter. A descriptive analysis of the data was performed.Results: All bypasses were constructed with an 8 mm ring enforced expanded polytetrafluoroethylene graft in a retrograde fashion (from infrarenal aorta or iliac artery) to either superior mesenteric artery or splenic artery (2 cases). Median operation time was 356 mins (range 247– 492 mins). Five patients had a history of unsuccessful endovascular treatment. Laparoscopic technical success was 78%, and the primary open conversion rate was 22%. All laparoscopic revascularization procedures remained patent after discharge during a median follow-up time of 26 months (range 18– 49 months). The primary graft patency at 30 days was 78%. Primary assisted, and secondary graft patency was 78% and 100%, respectively. Median weight gain was 2 kg (range 2– 18 kg), and all patients achieved relief from postprandial pain and nausea. No mortality was observed during the follow-up period.Conclusion: Laparoscopic aortomesenteric revascularization procedures for chronic mesenteric ischemia are feasible but require careful patient selection. These procedures should only be performed at referral centers by vascular surgeons with prior experience in laparoscopic vascular surgery.Keywords: mesenteric ischemia, bypass, laparoscopy, chronic mesenteric ischemia, intestinal ischemia
