Midline retroperitoneal versus midline transperitoneal approach for abdominal aortic aneurysm repair.
OBJECTIVE
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.
Third Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Japan. t_nakajima@imu.ncvc.go.jp
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T
Nakajima
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Kawazoe
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Komoda
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T
Sasaki
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Ohsawa
T
T
Kamada
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D006801:Humans; D010537:Peritoneum; D011183:Postoperative Complications / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods