title: Retroperitoneal repair of abdominal aortic aneurysms offers postoperative benefits to male patients in the Veterans Affairs Health System.
abstract: BACKGROUND
  Transperitoneal (TP) and retroperitoneal (RP) approaches have equal efficacy in elective open abdominal aortic aneurysm (AAA) repair. The effect of open operative approach on patient-specific outcomes after AAA repair was tested.
  
  
  METHODS
  Consecutive patients undergoing open AAA repair at the Veterans Affairs Tennessee Valley Healthcare System between January 2000 and August 2008 were retrospectively reviewed. Analysis was performed to examine the effects of demographic and clinical covariates on postoperative outcomes.
  
  
  RESULTS
  A total of 106 patients were identified: 54 with TP approach and 52 with RP approach. Demographics and preoperative comorbidities were equivalent (p > or = 0.10), with the exception of chronic obstructive pulmonary disease which was more prevalent in the TP group (61 vs. 40%). Operative times were longer in the TP group (4.6 vs. 3.5 hours; p < 0.01); however, significantly more TP patients had reconstruction with a bifurcated graft (72 vs. 2%; p < 0.01). Postoperative nasogastric tube decompression times were shorter in the RP group (1 vs. 3 days; p < 0.01), and RP approach led to a quicker return to preoperative diet (4 vs. 6 days; p = 0.05). Patients undergoing RP repair developed fewer incisional hernias (2 vs. 15%; p = 0.03).
  
  
  CONCLUSIONS
  RP approach to AAA repair offers patients faster return of bowel function and is associated with fewer incisional hernias.
authors.affiliation: Department of Surgery, Tennessee Valley Healthcare System, Nashville Campus, Nashville, TN, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Borkon
authors.forename: Victor
authors.initials: V
authors.lastname: Zaydfudim
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Carey
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Brophy
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Guzman
authors.forename: Jeffery B
authors.initials: JB
authors.lastname: Dattilo
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D003672:Defecation; D017558:Elective Surgical Procedures; D046449:Hernia, Abdominal / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D020127:Recovery of Function; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013714:Tennessee; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs