Transabdominal Versus Retroperitoneal Incision for Abdominal Aortic Aneurysm Surgery : Comparison of Three Retroperitoneal Approaches

From July 1987, when the retroperitoneal approach was first employed for the treatment of abdominal aortic aneurysm (AAA), to April 2003, elective AAA surgery was performed on a total of 209 patients in our department. Transabdominal incision (TAI) was performed in 61 patients ; paramedian retroperitoneal incision (PRI) in 27 patients ; Williams retroperitoneal incision (WRI) incision in 60 patients ; and midline retroperitoneal incision (MRI) in 61 patients. While there were no significant differences in age, gender ratio, or incidence of concomitant iliac vessel aneurysm among the four groups, the mean aneurysm diameter was larger in the TAI group than in the three retroperitoneal groups. Operative time was significantly shorter in the MRI group than in the TAI·group (288 ± 82 and 331 ± 88 minutes respectively, p<0.01) . No significant difference was apparent in the duration from start of skin incision to aortic clamp between the TAI group (105 ± 43 minutes) and the WRI or MRI groups (PRl group : 132± 128 minutes, WRI group : 108 ± 36 minutes, and MRI group : 119 ± 46 minutes) . Blood loss was significantly less in the MRI group than in the TAI group (p<0.01) (TAl group : 605 ± 355 g, and MRI : 447 ± 274 g) . Time to oral intake was reduced in the three retroperitoneal groups, with resumption of at least 75% oral intake being achieved in 9.3 ± 6.2 days for the TAI group, 5.9 ± 2.5 days for the PRI group, 5.3 ± 3.1 days for the WRI group and 5.5 ± 4.0 days for the MRI group (p<0.01) . When compared to the TAI group, postoperative hospital stay was shorter in the WRI and MRI groups. Postoperative course for the three retroperitoneal groups was therefore more favorable than for the TAI group, and in particular, MRI was shown to be useful in terms of recovery in intestinal function, additional skin incision and late abdominal bulge.