Abdominal surgery following coronary artery bypass grafting using an in situ right gastroepiploic artery graft.

OBJECTIVE The usefulness of the gastroepiploic artery (GEA) as arterial grafts in coronary artery bypass grafting (CABG) has been studied extensively. We report our experience performing abdominal surgery after CABG using in-situ GEA. METHODS The subjects were eight patients who underwent abdominal surgery after CABG with an in situ GEA graft. The surgical indications were malignant tumors in five patients, an infrarenal abdominal aortic aneurysm in two patients and a diaphragmatic hernia in one patient. The interval from the CABG to the abdominal surgery ranged from 3 to 19 months. RESULTS Operations included distal gastrectomy in two cases, total gastrectomy in one case, local excision of the stomach in one case, and excision of the transverse colon in one case. Aorto-biiliac artery bypass was performed in two cases, and the diaphragmatic hernia was reconstructed using standard techniques. When the skeletonization method has been used to harvest the GEA, GEA grafts were easily identified during a laparotomy, and the abdominal procedure was performed using routine methods. One patient died of cancer, and the other patients are alive 1 year 2 months to 4 years 5 months after surgery. No patient reported recurrence of angina. CONCLUSION The risk of abdominal reoperations should be considered when using the in situ right GEA for CABG. We recommend the skeletonization method for GEA harvest to decrease the difficulty during second abdominal operations.