MAIN RESULTS:

1. A decreased perioperative inflammatory response was found after the laparoscopic procedure.
2. Patients operated with a laparoscopic aortobifemoral bypass achieve earlier hormonal homeostasis after surgery.
3. Laparoscopic surgery is probably cost-effective compared to open surgery.

THESIS DEFENCE:

Thesis: Benefits of laparoscopic versus open aortobifemoral bypass surgery – focus on the surgical inflammatory reaction, humoral stress response and health economics
Candidate: Anne Helene Krog
Time: January 22, 2018 at 13:15
Place: Oslo University Hospital, Aker: Surgical Auditorium
Link to university website (in Norwegian)

SUMMARY:

(1) 30 patients with atherosclerotic lesions in the aortoiliac segment were randomized to either laparoscopic or open aortobifemoral bypass surgery. The researchers monitored the inflammatory response at six time points before, during and after surgery. Interleukin-6 was significantly lower after the laparoscopic procedure, whereas interleukin-8 and CRP levels were not significantly reduced.

(2) The researchers measured adrenocorticotropic hormone (ACTH), aldosterone, metanephrine and cortisol at eight different time-points to monitor the surgical stress response. All stress markers increased in both groups during surgery, but cortisol and ACTH returned faster to baseline values following laparoscopic surgery.

(3) Laparoscopic surgery tended to increase health-related quality of life more than open surgery. The increase in quality-adjusted life years was significantly higher following laparoscopic aortobifemoral bypass surgery. Furthermore, the total cost of surgery, equipment and hospital stay was lower following laparoscopic than open surgery. A total of 49 randomized patients were included in this cost-utility analysis.

REFERENCES:

(1) Krog, A. H., Sahba, M., Pettersen, E. M., Sandven, I., Thorsby, P. M., Jørgensen, J. J., Sundhagen, J. O. & Kazmi, S. S. (2016). Comparison of the acute-phase response after laparoscopic versus open aortobifemoral bypass surgery: a substudy of a randomized controlled trial. Vascular health and risk management, 12, 371.

(2) Krog, A. H., Thorsby, P. M., Sahba, M., Pettersen, E. M., Sandven, I., Jørgensen, J. J.,Sundhagen, J. O. & Kazmi, S. S. (2017). Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery. Scandinavian journal of clinical and laboratory investigation, 77(2), 83-92.

(3) Krog, A. H., Sahba, M., Pettersen, E. M., Wisløff, T., Sundhagen, J. O., & Kazmi, S. S. (2017). Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery. Vascular health and risk management, 13, 217.