Abdominal aortic aneurysmorrhaphy combined with biliary or gastrointestinal surgery

Abdominal aortic aneurysms occur in 2 to 5 per cent of the population over 60 years of age. Statistically, 7 per cent of patients with aneurysms will have associated cholelithiasis. The incidence of other concomitant intra-abdominal disease is much less. Because of the catastrophic complications associated with infection of synthetic aortic grafts, most authors have advised against opening a hollow viscus during aneurysm resection. Although Staphylococcus is the predominant organism responsible for graft infections, Szilagyi and associates and Liekweg and Greenfield found gram-negative organisms in 40 per cent of infected aortic prostheses. Thomas, Bickerstaff, and Fry and their coauthors have recommended caution when considering aneurysm resection and concomitant nonvascular operations. On the other hand, there is suggestive evidence that the risk of aneurysm rupture is increased in the postoperative period, especially if the aneurysm is greater than 6 cm in diameter. Therefore, optimum management of patients with aneurysms and other intra-abdominal pathology must reduce both the risk of graft infection and the risk of postoperative rupture. To reduce morbidity and mortality rates, careful preoperative evaluation for the detection and management of coexistent disease, the proper choice of intraoperative procedures, and close postoperative monitoring with prompt surgical intervention, as indicated, are essential.