Comparison between the transabdominal and retroperitoneal approach for reconstruction of the infrarenal abdominal aorta

To evaluate the efficacy of the retroperitoneal approach (RP) when compared with the transperitoneal (TP) approach in elective aortoiliac reconstruction, 104 consecutive cases were reviewed. From June 1983 through December 1985, 50 patients underwent aortoiliac reconstruction (26 for aortoiliac occlusive disease [AIOD] and 20 for abdominal aortic aneurysm [AAA]) through the TP approach and 54 patients underwent operation (30 for AIOD and 24 for AAA) through the RP approach. Both groups had similar revascularization procedures, associated diseases, and preoperative cardiac and pulmonary function parameters. The TP approach was associated with a larger intraoperative blood loss (1950 ± 196 ml) when compared with the RP approach (1296 ± 109 ml) (p < 0.001). The intraoperative crystalloid requirements were also significantly higher for the TP approach (5994 ± 296 ml) when compared with the RP approach (4455 ± 295 ml) (p < 0.0005). Similarly, the intraoperative blood requirements were higher for the TP approach (1235 ± 115 ml) than the RP approach (853 ± 61 ml) (p < 0.001). Both groups had similar operative times. Nasogastric intubation and initiation of oral feeding was significantly prolonged in the TP group when compared with the RP group (p < 0.001). Postoperative hospitalization was also considerably prolonged in the TP group when compared with the RP group (p < 0.02). This experience demonstrates that the RP approach is a preferable alternative to the TP route in elective aortoiliac reconstruction.