Retroperitoneal repair of abdominal aortic aneurysm reduces bowel dysfunction.
OBJECTIVE
To assess the effect of intestinal manipulation and mesenteric traction on gastro-intestinal function and postoperative recovery in patients undergoing abdominal aortic aneurysm (AAA) repair.


METHODS
Thirty-five patients undergoing AAA repair were randomised into 3 groups. Group I (n = 11) had repair via retroperitoneal approach while Group II (n = 12) and Group III (n = 12) were repaired via transperitoneal approach with bowel packed within the peritoneal cavity or exteriorised in a bowel bag respectively. Gastric emptying was measured pre-operatively (day 0), day 1 and day 3 using paracetamol absorption test (PAT) and area under curve (P(AUC)) was calculated. Intestinal permeability was measured using the Lactulose-Mannitol test.


RESULTS
Aneurysm size, operation time and PAT (on day 0 and day 3) were similar in the three groups. On day 1, the P(AUC) was significantly higher in Group I, when compared with Group II and Group III (P = .02). Resumption of diet was also significantly earlier in Group I as compared to Group II and Group III. The intestinal permeability was significantly increased in Group II and Group III at day 1 when compared with day 0, with no significant increase in Group I. Retroperitoneal repair was also associated with significantly shorter intensive care unit (P = .04) and hospital stay (P = .047), when compared with the combined transperitoneal repair group (Group II and III).


CONCLUSIONS
Retroperitoneal AAA repair minimises intestinal dysfunction and may lead to quicker patient recovery when compared to transperitoneal repair.
Arya
Nityanand
N
Vascular Unit, Belfast City Hospital, Belfast, United Kingdom. nityaarya@hotmail.com
Muhammad Anees Sharif
Lau
Luk Louis
LL
Lee
Bernard
B
Hannon
Raymond J
RJ
Young
Ian S
IS
Chee Voon Soong
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D004750:Enteral Nutrition; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007362:Intensive Care Units; D007408:Intestinal Absorption; D007410:Intestinal Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007413:Intestinal Mucosa / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011446:Prospective Studies; D020127:Recovery of Function; D012187:Retroperitoneal Space / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome