Intraabdominal nonvascular operations combined with abdominal aortic aneurysm repair

The therapeutic approach to a patient who has an abdominal aortic aneurysm (AAA) and an intraabdominal nonvascular surgical disorder simultaneously remains controversial. To establish guidelines for the management of those patients, a retrospective review of patients who had concomitant AAA and intraabdominal nonvascular surgical disorders was undertaken. During the period January 1988 to December 1997 a series of 162 patients underwent surgical repairs of AAA in our hospital. Among them 16 patients (9.9%) had several kinds of intraabdominal nonvascular surgical disorders, and 13 underwent one-stage operation for both diseases. That is, cholelithiasis coexisted in five patients, inguinal hernia in four, gastric cancer in two, and retroperitoneal tumor and renal tumor in one each. All AAAs were the infrarenal type, and there were no inflammatory or ruptured aneurysms. In cases of cholelithiasis coexistent with AAA, aneurysmectomy was performed first. After tight closure of the retroperitoneum, cholecystectomy was done. In cases of cholelithiasis coexistent with AAA, aneurysmectomy was performed first. After tight closure of the retroperitoneum, cholecystectomy was done. In cases of inguinal hernia coexistent with AAA, the AAA was first replaced with a prosthetic vascular graft and a residual piece of the graft was used as a patch for hernioplasty. This procedure was similar to laparoscopic hernioplasty. In two cases of gastric cancer concomitant with AAA, the AAA was first replaced. Subtotal gastrectomy with D2 lymphatic dissection was done after tight closure of the retroperitoneum. A drain was inserted into the epiploic foramen to detect anastomotic leakage. A retroperitoneal tumor coexisting with AAA was dissected and resected en bloc with the aneurysmal wall because the tumor firmly adhered to the aneurysm. The abdominal aorta was then replaced with a prosthetic graft. In a case of renal tumor concomitant with AAA, nephrectomy was done first to perform a complete lymphatic dissection around the renal artery. Then AAA repair was performed with a conventional procedure. There were no fatal complications, such as pneumonitis, hemorrhage, anastomotic leakage, or graft infection. All 13 patients were discharged from our hospital and are currently free from recurrence of malignancy or hernia. In summary, properly selected one-stage operations for intraabdominal nonvascular surgical disorders and AAA may be safe and bring physical and economic benefit to the patient.