Retroperitoneal approach to aortic surgery

The retroperitoneal approach has been recently advocated as an alternate approach to abdominal aortic surgery rather than the traditional transperitoneal approach. A comparative analysis of these two approaches was undertaken to clarify the differences. From June 1984 through June 1986, 172 patients underwent elective infrarenal abdominal aortic surgery on the Vascular Surgery Service at Eastern Virginia Medical School. One hundred nineteen were operated through a transperitoneal approach, and 53 through a retroperitoneal approach. The two groups were similar relative to age, sex, indications, risk factors and operations performed. The groups were then analyzed relative to operating time, blood transfusion, fluid replacement, ileus, morbidity, length of hospital stay, American Society of Anesthesiologists classification, and mortality. Significant differences were found: retroperitoneal patients had shorter operating time, shorter ileus, fewer cardiac complications, and shorter hospitalization than transperitoneal patients. This retrospective evaluation supports the conclusion that the retroperitoneal approach to abdominal aortic surgery is safe and beneficial in most patients. The retroperitoneal approach should therefore be given consideration in routine aortic surgery.