Left Retroperitoneal Versus Midline Transperitoneal Approach for Abdominal Aortic Aneurysms (AAAs) Repair
Kamphol Laohapensang, MD*, Kittipan Rerkasem, MD*, Narain Chotirosniramit, MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : The purpose of this prospective randomized study was to compare the left retroperitoneal approach
(RPA) with the midline transperitoneal approach (TPA) for infrarenal abdominal aortic aneurysms (AAAs)
repair with operative details, postoperative complications, and total cost comparision.
Materials and Methods : Between January 2000 and December 2003,36 patients undergoing elective surgery
for infrarenal AAAs were included in the prospective comparison of transperitoneal approach (TPA) with
retroperitoneal approach (RPA). Thirty-six patients were analyzed, with 18 in group 2 (TPA) and 18 in group
I (PRA). There was no significant differences between the groups in patient demographics. (p value > 0.05)
Results : There was no significant differences in the aortic cross clamp time, operative time, estimated blood
loss and intraoperative blood transfusion between the two groups (p value > 0.05); however, significantly
more intraoperative fluid needs and bowel function onset had a statistically longer return in group II (TPA)
than in group I (RPA). Statistically reduction in postoperative ileus (> 4 days) and total length of hospital
stay was observed in group I (RPA) (p value < 0.05). Postoperative cardiopulmonary complications were
statistically significantly more increased in group II (TPA) than in group I (RPA). Wound complications were
more in group I (RPA) (1 hematoma, 4 abdominal wall hernia, and 4 chronic wound pain) than in group II
(TPA) (2 chronic wound pain). Total cost payment was not significantly different in both groups.
Conclusion : The left retroperitoneal approach for infrarenal AAAs repair, with fewer cardiopulmonary
complications and shorter hospital stay has more unsatisfactory postoperative wound complications than
the midline transperitoneal approach.
Keywords : Abdominal aortic aneurysms, Retroperitoneal approach, Transperitoneal approach
