Perioperative serum cortisol levels at different operative accesses to femoral segment arteries

Aim. To compare invasiveness of reconstructive operations on arteries of aortofemoral segment using different accesses to surgical site. Methods. The analysis of the post-operative period was carried out in 40 patients who underwent aortofemoral bifurcation bypass surgery. Patients were assigned to 4 groups, each containing 10 patients. In group I surgeries were performed using mini-access of 5-7 cm, group II - mini-laparotomic access of 8-12 cm, group III - retroperitoneal mini-access, group IV - standard laparotomy. For invasiveness objectification, serum cortisol levels, forced lungs vital capacity and postoperative pain levels were measured. Results. All surgeries were performed as planned without inoperative complications. No deaths were registered. After mini-access surgeries intestinal peristalsis was defined by auscultation as soon as on 18-24 hour after the operation. Prolonged (more than 3 days) post-operative ileus was diagnosed in 3 patients, all operated using standard laparotomy. Serum cortisol level was typically elevated at the end of the surgery, but the difference was only statistically significant in patients from the group IV compared to baseline level as well as to patients with mini-access surgeries. Serum cortisol level reduced to normal at the second 24-hours after the surgery. Patients in which standard laparotomy was used reported more intense pain at the second day. Forced lungs vital capacity at day 4 was significantly reduced in patients of groups I, III and IV, with the significantly worse reduction in patients who overcame standard laparotomy compared to others. Conclusion. Mini-access reconstructive surgeries on aortofemoral segment arteries provide significant reduction of surgical trauma, which is proved by objective measurements.

mini-access, bifurcation aortofemoral bypass, cortisol, forced lungs vital capacity