Key result
Retroperitoneal open AAA repair linked to ~70% less postoperative morbidity versus transperitoneal approach.
Why the study?
Transperitoneal approach is the most common surgical approach for open AAA repair in the UK, but the retroperitoneal approach is favored for more complex vascular anatomy, warranting a comparison of approaches in matched patients.
Does the retroperitoneal approach reduce postoperative morbidity and systemic inflammation compared to the transperitoneal approach in patients undergoing open abdominal aortic aneurysm repair?
Observational (n=57)
No
Does the retroperitoneal approach reduce postoperative morbidity and systemic inflammation compared to the transperitoneal approach in patients undergoing open abdominal aortic aneurysm repair?
Absolute Event Rate: 24% vs 79%
p-value: p=<0.001
The retroperitoneal approach for open abdominal aortic aneurysm repair is associated with significantly reduced systemic inflammation, fewer gastrointestinal complications, and shorter hospital stays compared to the transperitoneal approach.
May support retroperitoneal approach in open AAA repair; hypothesis-generating and requires randomized confirmation.
Background In the United Kingdom, the most common surgical approach for repair of open abdominal aortic aneurysms (AAAs) is transperitoneal (TP). However, retroperitoneal (RP) approach is favored in those with more complex vascular anatomy often requiring a cross-clamp on the aorta superior to the renal arteries. This study compared these approaches in patients matched on all major demographic, comorbid, anatomic, and physiological variables. Methods Fifty-seven patients (TP: n = 24; RP: n = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded. Results Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients (p = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps (p < 0.001 vs. IR clamp). RP patients were defined by lower LoS (p = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings. Conclusion Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair.
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Bailey et al. (2022) conducted an observational in Abdominal aortic aneurysm (n=57). Retroperitoneal approach vs. Transperitoneal approach was evaluated on Clinically significant postoperative morbidity (POMS score ≥ 1) (p=<0.001). The retroperitoneal approach for open abdominal aortic aneurysm repair significantly reduced clinically significant postoperative morbidity (24% vs 79%, p<0.001) compared to the transperitoneal approach.
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