Laparoscopic Aortic Surgery in Obese Patients

Background: Our objective was to demonstrate the feasibility of laparoscopic abdominal aortic aneurysm ( AAA) repair in obese patients and to confirm advantages observed with laparoscopic techniques in other surgical specialties regarding pulmonary and parietal complications in this population. Methods: Between November 2000 and December 2007 we performed 37 laparoscopic aortic reconstructions in obese patients ( body mass index [BMI] > 30 kg/m(2)). Median BMI was 31.9 kg/m(2) ( range 30.1-40). Twenty-seven patients (73%) were operated for AAA and 10 (27%) for TASC C or D aortoiliac occlusive disease. Data were gathered prospectively and analyzed retrospectively. Results: Aortic exposure was totally laparoscopic in 36 patients (97.3%). Median operative time was 290 min ( range 160-480). Median duration of clamping was 77.5 min ( range 40-105). Orotracheal extubation was possible before H24 for 35 patients (95%). Median lengths of intensive care unit stay and hospital stay were, respectively, 48 hr ( range 12-624) and 8 days ( range 4-35). One patient (2.7%) died postoperatively because of colonic ischemia. Five systemic postoperative complications were observed in 36 patients who survived (13.5%) including major nonlethal postoperative complications in two patients (pneumopathy and acute hemodynamic lung edema). All other patients had a fast recovery, with minimal wound discomfort and rapid return to general diet and ambulation, with a median follow-up of 21.5 months ( range 1-78). One patient was lost. Complete recovery was observed in 35 other patients, and all grafts were patent at last follow-up. No graft infection was observed, and none of our patients presented incisional hernia. Conclusion: Obesity is not an operative risk factor for laparoscopic aortic surgery. Our results confirm its feasibility and durability for this high-risk population. Laparoscopy should be considered as the technique of choice whenever direct AAA repair is planned in obese patients.