Key result
The retroperitoneal approach for abdominal aortic reconstruction significantly reduced postoperative ileus (0.0% vs 10.0%, P<0.001) and pulmonary complications compared with the transperitoneal approach.
Why the study?
Does the retroperitoneal approach reduce postoperative complications and inflammatory response (IL-10) compared to the transperitoneal approach in patients undergoing abdominal aorta reconstruction?
RCT (n=100)
Randomly allocated
Does the retroperitoneal approach reduce postoperative complications and inflammatory response (IL-10) compared to the transperitoneal approach in patients undergoing abdominal aorta reconstruction?
Absolute Event Rate: 0% vs 10%
p-value: p=<0.001
The retroperitoneal approach for abdominal aortic reconstruction is associated with a reduced inflammatory response, fewer pulmonary and gastrointestinal complications, and a shorter hospital stay compared to the transperitoneal approach.
Supports retroperitoneal preference in abdominal aortic reconstruction to reduce complications; confirms RCT-level superiority over transperitoneal approach.
BACKGROUND: To compare retroperitoneal (RP) vs. transperitoneal (TP) approaches in abdominal aorta reconstruction in terms of operative characteristics, plasma interleukin-10 levels and postoperative complications. METHODS: A total of 100 patients scheduled for elective abdominal aortic surgery for occlusive disease under general anesthesia from May 2005 to January 2010 were included in this prospective study with allocation of patients randomly to TP approach (n = 50 ; mean (SD) age : 64.3 (4.0) years ; 76.0% were males) or RP approach (n = 50 ; mean (SD) age : 63.8 (5.6) years ; 75.0% were males) for aortic surgery. Demographic data, risk factors, perioperative and postoperative data and IL-10 levels were analyzed in two groups. RESULTS: TP approach was associated with higher levels for IL-10 measured at the time of T1 (before unclamping of aorta) [(8.4 (5.1) vs. 6.5 (4.9) pg/mL, p < 0.05)] and T2 (sixty minutes after declamping) [(11.7 (6.0) vs. 8.3 (6.2) pg/mL, p < 0.01)] compared with RP approach. Postoperative evaluation revealed a higher percentage of patients with postoperative ileus (10.0 vs. 0.0%, p < 0.001) and pulmonary complications (18.0 vs. 4.0%, p < 0.001) in the TP rather than RP groups. The TP and RP groups were similar in terms of mortality rates whereas TP approach was associated with longer mean (SD) length of hospital stay (6.2 (1.0) vs. 3.8 (1.0) days, p < 0.001) compared with the RP approach. CONCLUSIONS: Our findings revealed that the RP approach has significant advantages over the TP approach in aortic reconstruction surgery leading better pulmonary function and low ileus rate in the postoperative period as well as shorter length of hospital stay. While an increase in IL-10 levels was reported in both approaches, probably in relation to higher degree of tissue trauma, the increase was more profound in the TP approach.
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Erkalp et al. (2014) conducted an RCT in Occlusive disease requiring abdominal aortic surgery (n=100). Retroperitoneal (RP) approach vs. Transperitoneal (TP) approach was evaluated on Postoperative ileus (p=<0.001). The retroperitoneal approach for abdominal aortic reconstruction significantly reduced postoperative ileus (0.0% vs 10.0%, P<0.001) and pulmonary complications compared with the transperitoneal approach.
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