Reflections on:
Comments:
Two very interesting points should always be remembered:
- Despite the fact that many observational reports showing significant reduction in 30-day- mortality rate, this systematic review has shown that the improvement does not exceed 10%. It is possible that the trials that managed eventually to recruit patients in such unstable condition has, be default, underwent selection bias toward people with better outcome anyway.
- The physiologic medical logic support the idea that approaching the bleeding (ruptured AAA)via mini invasive surgery would be less harmful and less shocking to doing that with a wider laparotomy incision. The long-term results, however, is not only dependent on the access but also on the overall organ dysfunction during the period from rupture to bleeding cessation. See the comments by Lindholt er al.