Bypass aortobifemoral por vía transperitoneal retrocólica totalmente laparoscópico

A 52-year-old male with agenesis of the left kidney and preserved renal functioning; the patient presented a clinical picture of progressive claudication at less than 50 m for the left lower limb (LLL), and somewhat longer for the right calf. Vascular exploration: absence of pulses in LLL; in the right: weak femoral, and absence of popliteal and distal pulses. Left ankle-brachial index: 0.42; right: 0.67. Because of the patient's age, the clinical picture of claudication that left him largely unable to do his work and the extension of the angiographic lesions (class D TASC II) an aortobifemoral bypass was indicated; we also considered the possibility of performing this procedure by means of a laparoscope. The patient was placed on his side 80° to perform the retrocolic transperitoneal path. Over-and-over end-to-side suture by means of two CV3 polytetrafluoroethylene (PTFE) hemisutures to a 16 × 8 mm bifurcated Dacron graft with zero patency. Suturing time was 1 h 35 min; total time 7 h. Extubation at 4 h; length of stay in resuscitation: 16 h; analgesic intake: three 30 mg doses of morphine chloride, in the first 24 h; audible peristalsis at 24 h; diet was re-established at 48 h. The patient suffered an episode of gouty arthritis at 48 h, which was treated with nonsteroidal antiinflammatory drugs, and was discharged from hospital with positive distal pulses on the 6th day.