[Injuries to the abdominal aorta during laparoscopy]

Abstract

Member surgeons of the Société de Chirurgie vasculaire de Langue française participated in a survey concerning traumatic injury to the aorta and retrospectively reported nine cases of injury occurring during laparoscopic operations. Six had occurred in 1991 when video-laparoscopic surgery was becoming widespread. The laparoscopy had been indicated as a diagnostic procedure in 4 cases and for curative treatment in 5. Gynaecology disease were involved in 4 cases and digestive diseases in 5. Injury was reported near the aortic bifurcation or at the origin of the common right iliac artery. Concomitant injury to the small intestine (1 case) and to the mesentery (n = 3) were also reported. No venous injury was observed. Haemodynamic collapsus was the presenting sign and occurred early in 6 cases and late in 2. In 1 case, the haemorrhage occurred during the laparoscopic procedure itself and in another blood loss was visualized through the needle. An unsuccessful and unneeded procedure had been performed before the diagnosis in 4 cases: on splenectomy, two mesenteric dissections and one subcostal laparotomy after cholecystectomy. In all cases, the vascular surgeon had been called in by the operating surgeon and most often operated via the xypho-pubien route. After clamping the aorta, the vascular lesions was sutured. There was one death, directly related to late diagnosis. The frequency of injury to the abdominal aorta found in the literature and the difficulties in diagnosis was recalled. Mortality has been reported to vary between 13 and 23%. Such complications demonstrate the need for a rigorous technique but do not counterindicate the continued use of laparoscopic procedures.