Transperitoneal versus retroperitoneal approach for aortic reconstruction: a randomized prospective study

Recommendations for the use of a retroperitoneal rather than a transperitoneal approach for reconstruction of the aorta are usually based on clinical observations of morbidity and mortality. The traditional transperitoneal approach uses an incision down the middle of the abdomen; the retroperitoneal approach is made across the lower abdomen to the tip of the eleventh rib at the side of the body. A prospective study was undertaken to evaluate and compare these two different approaches; 59 patients had the transperitoneal procedure and 54 had the retroperitoneal procedure. A second group was evaluated retrospectively; these patients underwent aortic reconstruction using the transperitoneal approach three years earlier. The randomized patients were similar in age, male/female ratio, smoking history, incidence and severity of heart-lung disease, indications for operation, and past history of anesthetic use. Respiratory impairment and other aspects of postoperative recovery, including recovery of bowel function, need for narcotics, complications, duration of hospital stay, were similar in the two randomized groups. Compared with the early group of patients, there was significant reduction in need for mechanical respiration, blood transfusions, and length of hospitalization in patients who had either procedure. Overall, no important advantages were demonstrated for the retroperitoneal approach to aortic reconstructive surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)