ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Abdominal aortic aneurysm surgery: retroperitoneal or transperitoneal approach?
Bayer Çınar1, Onur Göksel 1, Hakkı Aydoğan 1, Uğur Filizcan 1, Şebnem Çetemen1
1Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul
2Department of Anesthesiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul
Background: Mortality and morbidity of abdominal aortic aneurysm surgery have decreased significantly in time and transperitoneal approach still preserves its firm ground although retroperitoneal approach is known to serve with various advantages. In this study, two approaches were compared for elective and emergency cases.

Methods: Patients that underwent abdominal aortic aneurysm repair between January, 1994 and March, 2004 were reviewed and analyzed based on the elective/emergent nature of the surgery and the type of the incision. Preand perioperative data including hospital mortality and various morbidities were analyzed.

Results: Fourty five patients were operated with retroperitoneal approach (RPA) among 155 patients and 35 patients had a ruptured aneurysm in 10 years period. Significantly shorter mechanical ventilation and nasogastric decompression periods, less need for intravenous fluid supplementation with shorter ICU stay were observed with the RPA (p<0.001). Need for allogenic blood transfusion was similar (p>0.05). Analysis of mortality and morbidity revealed bleeding as the major cause of mortality in the ruptured cases. A similar comparison between two groups, however, revealed no significant difference (p>0.05).

Conclusion: Retroperitoneal approach serves many advantages as rapid weaning from mechanical ventilation and shorter stay in intensive care unit in addition to rapid restoration of gastrointestinal physiology. It also provides adequate surgical exposure.

Keywords : Abdominal aorta; aneurysm; retroperitoneal
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