Wound complications of the retroperitoneal approach to the aorta and iliac vessels

Repeated complaints of postoperative wound pain prompted this review of 113 consecutive vascular operations involving a retroperitoneal approach to the aorta or iliac vessels or both. Flank muscle-splitting incisions (n = 53) had been used to approach the terminal aorta or iliac arteries. Two types of muscle-dividing incisions had also been used: incisions through the eleventh intercostal space (n = 41) to approach the infrarenal aorta; and incisions through the eighth, ninth, or tenth intercostal space with division of the diaphragm (n = 19) to approach the suprarenal aorta. Data on incisional pain, lumbosacral neuritic pain, incisional hernia, and deforming abdominal bulge were culled from the records of follow-up examinations conducted on all patients during periods ranging from 2 to 48 months. Both types of muscle-dividing incisions used to expose the aorta were associated with a 23% (14/60) incidence of abdominal bulge, a 7% (4/60) incidence of incisional hernia, and, more important, a 37% (22/60) incidence of prolonged disabling pain. Thus, although retroperitoneal exposure may be the preferred or the safest approach to certain aortic lesions, its routine use via muscle-dividing incisions is not recommended when the proposed operation can be carried out equally well by the conventional midline transperitoneal approach.