The Retroperitoneal Approach for Abdominal Aortic Aneurysms
KAMPHOL LAOHAPENSANG, M.D.*, ARAM PONGCHEOWBOON, M.D.*, KITTIPAN RERKASEM, M.D.*
Affiliation : *Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Graft replacement has become the reliable and effective form of treatment for abdominal
aortic aneurysms (AAA). Operative therapy remains the major undertaking with significant rates
of postoperative morbidity and mortality. The use of retroperitoneal approach has been proposed
as an alternative to standard midline transabdominal approach. Over a 5 year period, 43 con-
secutive nonrandomized infrarenal AAA patients underwent elective surgical correction by the
authors. 32 patients with the mean age of 75 underwent transabdominal reconstructive procedures
for AAA. The average size of AAA was 5.9 em and operative time was 3 hours and 25 minutes.
The mortality rate was 6.25 per cent (2 of 32). The cause of death was myocardial infarction I, and
acute renal failure 1. There are many complications in the transabdominal group. 11 had prolonged
ileus, 2 MI, 2 wound dehiscence, 2 atelectasis, 1 acute renal failure and 1 chylous ascites. In 11
patients with retroperitoneal approach, the average size of AAA was 5.6 em and operative time
was 3 hours and 29 minutes. No operative mortality, the only 1 complication was retroperitoneal
hematoma.
The most notable difference between the retroperitoneal group and transabdominal
group was the speed and ease of postoperative recovery. The patients in the retroperitoneal group
needed a shorter period of intubation, nasogastric drainage, stay in the intensive care unit and
hospital. Patients in the retroperitoneal group also resumed oral alimentation sooner, shorter and
smoother postoperative course. The patients in the retroperitoneal group had less blood loss and
fewer transfusions than in the transabdominal group.
Findings from our experience using the left retroperitoneal approach for a reconstruc-
tive procedure of AAA indicate that it results in fewer overall physiologic disturbances of the
patients. We believe that the left retroperitoneal approach is a useful surgical access of choice
for the elective repair of AAA.
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