Midline laparotomy and right retroperitoneal dissection is an alternative exposure for routine aortic surgery

In most atlases of vascular surgery, laparotomy and right retroperitoneal dissection with reflection of the right colon and a wide Kocher maneuver is either briefly described as an alternative exposure for the abdominal aorta under special circumstances or not described at all. This approach offers certain advantages over the two more commonly described and widely used exposures, however, and should be considered for use in both routine and complex cases. The author reports his experience with the use of midline laparotomy and right retroperitoneal dissection (MLRRD) for elective aortic operations. Review of 100 consecutive abdominal aortic operations by the author was performed. During this period, the author changed from using a standard approach of midline retroperitoneal incision below the transverse mesocolon for routine aortic surgery to using MLRRD as the exposure of choice for routine aortic surgery. Measured outcomes included operative time, complications, perioperative blood transfusions, and length of hospital stay. Outcomes were equivalent between the two approaches. Use of MLRRD results in no significant difference in outcomes compared with the standard infracolic aortic approach and affords unique advantages. Surgeons may wish to routinely consider this alternative exposure of the abdominal aorta.