Extraperitoneal Access to the Abdominal Aorta

Abstract

The authors report their experience with the use of the extraperitoneal ap proach to the abdominal aorta and iliac arteries in 52 patients, observed between 1980 and 1989. In all the cases a left paramedian incision was done. In 35 pa tients with aortoiliac occlusive disease some type of aortoiliac or aortofemoral bypass was done. In 14 cases of infrarenal aneurysm of the abdominal aorta, aorto-aortic replacement was done in 5, aortoiliac bypass in 7, and aortofemoral bypass in 2 patients. In 3 patients with occlusive disease of the iliac arteries, throm boendarterectomy was performed.

The results with extraperitoneal approach to the abdominal aorta and its main branches in the 52 patients were considered very good, when compared with those when the transperitoneal route was used in 72 cases. In the evaluation of results the authors used the following parameters: blood and fluid loss, operative time, intensive care unit time, pulmonary and cardiac complications, postoperative ileus, beginning or oral feeding, time of hospitalization, and mortality.

The extraperitoneal group was associated with less blood less (1,120 mL) than that with the transperitoneal route (1,850 mL) (p<0.01). The operative time was longer with the transperitoneal route. The intensive care unit time was less with the extraperitoneal approach (1.6 days) than with the transperitoneal route (3 days). The cardiopulmonary support time was longer the transperitoneal (2.5 days) than in the extraperitoneal group (1.3 days). Postoperative ileus was not observed in the extraperitoneal group but was present in several cases in the trans peritoneal group. The period of time for the patients to start a solid diet was significantly less in the extraperitoneal group.

Finally, the number of deaths was smaller in the extraperitoneal group. Their experience cooroborates the similar conclusions of other authors that the extraperitoneal access is the better option in elective aortic reconstruction.