Retroperitoneal approach for aortic surgery: is it worth it?

Systematic Review and Meta-analysis of the Retroperitoneal versus the Transperitoneal Approach to the Abdominal Aorta

“…Intensive care stay was significantly lower in the RP group in six of 14 studies, 20,23,24,28,32,41 with the remaining 8 showing a non-significant trend towards a shorter stay in the RP group (Table 6). 5,15,21,22,25,31,33,37 This translated to a significantly shorter ICU stay in RP patients on meta-analysis (SMD À0.67…”

“…2). Three 23,28,36 of sixteen studies showed that pneumonia was significantly less common in the RP group. 5,15e17,21,23,25,27e 30,32,33,36,37,42 Combined with a trend favouring the RP groups in the other studies, this translated to a significant reduction in post operative pneumonia in the main analysis (OR 0.42 [0.26, 0.68], p ¼ 0.0004).…”

Surgical Technique and Peripheral Artery Disease

“…Compared with the transabdominal approach, the retroperitoneal approach is associated with a lower incidence of pulmonary complications, rapid recovery of gastrointestinal function, and shorter intensive care unit and hospital stays. 38,39 Aortobifemoral bypass grafts are constructed to provide straight-line flow to the femoral arteries and to preserve flow to the internal iliac, inferior mesenteric, and lumbar arteries when patent. When the common iliac arteries are occluded, perfusion to the hypogastric arteries is supplied retrograde via the external iliacs.…”

Eversion endarterectomy of the external iliac artery

“…Also, less pain intensity reported by the patients and smaller consumption of analgesics have been noted. The risk of postoperative pulmonary complications is smaller, patients are extubated sooner and their stay at ICU is shorter [26][27][28][29].…”