The left paramedian extraperitoneal approach for aortic reconstructive surgery

Seventy-five consecutive aortic reconstructive procedures were performed via a left paramedian extraperitoneal approach. These operations included abdominal aortic aneurysmectomies in 28 patients and aortobifemoral grafts in 43. These were combined with aorto-left-renal bypass in four patients and removal of infected aortic prostheses in four other patients. This modified technic obviated the need for excessive retraction by combining the benefits of a paramedian approach with a full-length abdominal incision. Distinct advantage include decrease postoperative abdominal discomfort, minimal paralytic ileus, as well as a shortened convalescence. This extraperitoneal approach is not only suitable for routine aortic reconstructive procedures, but has proven to be especially valuable in cases where increased morbidity is likely with infringement of the peritoneal cavity, such as patients with extensive bowel adhesion, previous colostomy, or infection aortic grafts requiring removal.