title: The less incisional retroperitoneal approach for abdominal aortic aneurysm repair to prevent postoperative flank bulge.
abstract: One of the postoperative complications of retroperitoneal incision is a flank bulge that is suggested to be caused by 11th intercostal nerve injury leading to denervation of the ipsilateral muscles. To avoid this complication, we have tried to minimize retroperitoneal incision for abdominal aortic aneurysm (AAA) repair. The feasibility of the less incisional retroperitoneal approach for the repair of AAA to prevent postoperative flank bulge was investigated. Twenty-seven patients undergoing elective repair for infrarenal AAA through the left retroperitoneal approach were divided into group-L (less incision: 11.9+/-1.8 cm, n = 7) and group-C (conventional incision: 17.8+/-1.9 cm, n = 20). All operations were performed by a traditional hand-sewn anastomosis without laparoscopic support. Five bifurcated grafts were used in group-L and 15 in group-C. The postoperative course of all patients was uneventful except that one patient in group-C required reoperation for bleeding. Intraoperative parameters of both groups were almost comparable. All patients in group-L were extubated in the operating theater, whereas it was possible only for 11 patients in group-C. Resumption of alimentation was significantly earlier in group-L (P = 0.0117). There was no significant difference in postoperative hospital stay between groups. No late flank bulge was experienced. Significant late atrophy of the left rectus muscle (left/right thickness-ratio = 0.59+/-0.24) was seen in group-C (P = 0.0042 vs preoperative value), which was not observed in group-L (P = 0.0008 between groups). The less incisional retroperitoneal AAA repair seems feasible and safety technique that might prevent postoperative flank bulge and reduce surgical stress.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan. kunihara@med.hokudai.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Kunihara
authors.forename: A
authors.initials: A
authors.lastname: Adachi
authors.forename: F
authors.initials: F
authors.lastname: Akimaro Kudo
authors.forename: N
authors.initials: N
authors.lastname: Shiiya
authors.forename: K
authors.initials: K
authors.lastname: Yasuda
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009133:Muscular Atrophy / Q000209:etiology; D017568:Rectus Abdominis / Q000473:pathology; D012187:Retroperitoneal Space / Q000601:surgery*; D016896:Treatment Outcome