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Midline retroperitoneal versus midline transperitoneal approach for abdominal aortic aneurysm repair
T Nakajima1, K Kawazoe, K Komoda
1Third Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Japan. t_nakajima@imu.ncvc.go.jp
Purpose:
The purpose of this study was to compare the midline retroperitoneal approach with the midline transperitoneal approach for abdominal aortic aneurysm (AAA) repair with respect to operative details, gastrointestinal complications, and wound complications.
Methods:
From January 1990 through January 1998, 128 patients underwent elective aortic reconstruction for infrarenal AAA. Of these, 64 patients (the transperitoneal group) underwent conventional transperitoneal midline aortic exposure, whereas the remaining 64 patients (the retroperitoneal group) underwent retroperitoneal midline exposure of the aneurysm.
Results:
Preclamp time, that is, the time from skin incision to aortic clamping, was significantly shorter in the transperitoneal group than in the retroperitoneal group (P <.001). However, the midline retroperitoneal approach was associated with decreased incidence of ileus (P <.01), earlier resumption of oral intake (P <.01), and decreased wound pain (P <.01), in comparison with the transperitoneal approach. Furthermore, there was no incidence of wound complications such as abdominal bulge or wound pain in any of the patients in the postoperative period or over the long term.
Conclusions:
The midline retroperitoneal approach for AAA was associated with fewer postoperative gastrointestinal and wound complications than the midline transperitoneal approach. Over the long term, there was no wound complication such as abdominal bulge and wound pain in any of the patients.
Insights
The midline retroperitoneal approach for abdominal aortic aneurysm (AAA) repair leads to fewer gastrointestinal and wound complications compared to the transperitoneal approach. Long-term follow-up showed no wound complications like abdominal bulge or pain with the retroperitoneal method.
Area of Science:
- Vascular Surgery
- Surgical Approaches
- Abdominal Aortic Aneurysm
Background:
- Abdominal aortic aneurysm (AAA) repair necessitates careful surgical approach selection.
- Minimizing postoperative complications is crucial for patient recovery.
- Comparing transperitoneal and retroperitoneal methods is essential for optimizing AAA treatment.
Purpose of the Study:
- To compare midline retroperitoneal and transperitoneal approaches for AAA repair.
- To evaluate operative details, gastrointestinal complications, and wound complications.
- To determine the optimal surgical strategy for infrarenal AAA.
Main Methods:
- A comparative study of 128 patients undergoing elective infrarenal AAA repair.
- 64 patients in the transperitoneal group (conventional midline aortic exposure).
- 64 patients in the retroperitoneal group (midline retroperitoneal exposure).
Main Results:
- The transperitoneal approach had a shorter preclamp time.
- The retroperitoneal approach showed decreased ileus and earlier oral intake resumption.
- The retroperitoneal approach resulted in significantly less wound pain and no long-term wound complications.
Conclusions:
- The midline retroperitoneal approach for AAA repair is associated with fewer postoperative gastrointestinal and wound complications.
- This approach offers advantages in terms of patient recovery and long-term outcomes.
- Midline retroperitoneal approach is a favorable option for infrarenal AAA repair.