ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2018 December;25(4):309-13

DOI: 10.23736/S1824-4777.18.01283-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Retroperitoneal versus transperitoneal approach for aortoiliac occlusive disease: a comparative study

Haider R. NEAMAH ¹, Akeel S. YUSR ², Qays A. HASSAN ³ ✉, Wael M. AL-SAADAWY ⁴

¹ Unit of Cardiovascular Surgery, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq; ² Department of Surgery, Ibn Al-Nafees Hospital, Baghdad, Iraq; ³ Unit of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq; ⁴ Babil Health Directorate, Baghdad, Iraq

BACKGROUND: Aortoiliac occlusive disease (AIOD) is among the most common forms of chronic obliterative atherosclerosis. The objective of this study was to compare intraoperative and postoperative data of retroperitoneal (RP) and transperitoneal (TP) approaches for AIOD surgery to find optimal approach.
METHODS: From March 2010 to December 2016, 216 patients underwent elective aortoiliac reconstructive surgery were enrolled in this cross-sectional study. RP approach was performed to 134 patients and TP approach was performed to 82 patients. Preoperative demographic data and risk factors, intraoperative and immediate postoperative characteristics and late postoperative complications were statistically analyzed and compared between the two approach groups.
RESULTS: We found statistically significant difference in five of six immediate postoperative parameters in favor of the RP approach. Patients operated with RP approach had an earlier resumption of oral fluids intake (P=0.000), faster onset of bowel function return (P=0.000), shorter period of intensive care unit (P=0.000) and hospital stay (P=0.000) and milder severity of postoperative pain (P=0.000). Postoperative complications were significantly less in the RP group such as pulmonary complications (P=0.000), incisional hernia (P=0.000), wound infection (P=0.002) and prolonged ileus (P=0.010). No statistically significant difference was observed in demographic data and risk factors.
CONCLUSIONS: Better surgical outcomes were achieved with RP approach at the surgical treatment of AIOD. RP technique provides better recovery course resulting in lower financial implications.

KEY WORDS: Retroperitoneal space - Arterial occlusive diseases - Atherosclerosis - Surgery