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

Abstract

The RP approach for open aortic surgery is associated with lower rates of postoperative ileus and pneumonia when compared to the TP approach.

Left retroperitoneal aortic aneurysm repair in patients unsuitable for endovascular treatment

“…In the series by Richards et al ., surgery was performed transperitoneally with medial visceral rotation. TP aortic surgery has been shown to be associated with higher in hospital complication rates than a totally extraperitonal approach, which is in keeping with the results seen here. Thoracoabdominal repairs were included for comparison of intra‐abdominal complication rates when examining the totally RP approach to the aorta.…”

“…This is especially relevant in the endovascular era as aneurysms unsuitable for EVAR/FEVAR often require high clamps. Additionally, there appears to be a reduced risk of post‐operative complications and a shorter post‐operative stay after a totally RP approach as compared to a transperitoneal (TP) approach with medial visceral rotation …”

Técnicas quirúrgicas en la patología oclusiva aorto-ilíaca

“…Arteriografía diagnóstica de paciente con obstrucción término-aórtica y de ambos ejes ilíacos. digestivas y respiratorias, menor estancia en la Unidad de Cuidados Intensivos y menor coste por procedimiento en los pacientes sometidos a abordaje retroperitoneal en comparación con aquellos intervenidos por vía transperitoneal 13,14 .…”

Commentary on ‘Systematic Review and Meta-analysis of the Retroperitoneal Versus the Transperitoneal Approach to the Abdominal Aorta’

“…As the indication for open surgery has changed with the introduction of EVAR, the RP approach is likely to become increasingly important. As pointed out by Twine et al 1 the reduced number of open surgical repairs is a point of concern from a training point of view. Future vascular surgeons should be familiar with this approach and should consider it when open surgical repair is indicated.…”

“…In this meta-analysis, the auteurs claim there may be clinical benefits to performing this surgery via a retroperitoneal (RP) approach. 1 The reduction in mortality of elective infrarenal repairs has been substantial since it was developed. 2 However, this reduction is a result of several factors, such as patient selection, medical treatment, aesthetic techniques, and improved care in intensive care units, and not the surgical technique per se.…”