Extraperitoneal approach in surgery for abdominal aorta aneurysms

The extraperitoneal approach to the infrarenal abdominal aorta has been shown to be feasible from the early days of aortic surgery, however only in recent times has it been employed widely at several different institutions with encouraging results. The aim of this study is to evaluate the extraperitoneal approach for the surgical treatment of infrarenal abdominal aortic aneurysms. Between April 1992 and April 1993, 16 patients underwent aneurysmectomy and aorto-aortic reconstruction with a prosthetic graft (8 Dacron - 8 ePTFE Stretch) employing a transverse left flank limited incision and a retroperitoneal approach to the aorta. Mean operative time was 150 ± 38 minutes, mean aortic clamping time 32 ± 11 minutes, mean bleeding 690 ± 321 cc. One patient required reoperation for bleeding which was carried out through a midline incision. No mortality was recorded. The postoperative course was subjectively less painful then in the patients operated through a midline transperitoneal incision. Naso-gastric tube was removed in II postoperative day and postoperative ileum was reduced in these patients. No cardiac or respiratory complications were recorded and the patients were discharged usually occurred on V postoperative day. In conclusion a limited extraperitoneal approach is useful for the treatment of aneurysms of the infrarenal aorta: aneurysmectomy and aorto-aortic grafting are technically feasible through this route and the postoperative course is short and well tolerated by the patient.