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Retroperitoneal Repair of Abdominal Aortic Aneurysm Reduces Bowel Dysfunction

Vascular Unit, Belfast City Hospital, Belfast, United Kingdom, nityaarya{at}hotmail.com

Muhammad Anees Sharif, MD

Vascular Unit, Belfast City Hospital, Belfast, United Kingdom

Luk Louis Lau, MD

Vascular Unit, Belfast City Hospital, Belfast, United Kingdom

Bernard Lee, FRCS

Vascular Unit, Belfast City Hospital, Belfast, United Kingdom

Raymond J. Hannon, MD

Vascular Unit, Belfast City Hospital, Belfast, United Kingdom

Ian S. Young, MD

Department of Medicine, Queen's University, Belfast, United Kingdom

Chee Voon Soong, MD

Vascular Unit, Belfast City Hospital, Belfast, United Kingdom

Objective: To assess the effect of intestinal manipulation and mesenteric traction on gastro-intestinal function and postoperative recovery in patients undergoing abdominal aortic aneurysm (AAA) repair. Methods: Thirty-five patients undergoing AAA repair were randomised into 3 groups. Group I (n = 11) had repair via retroperitoneal approach while Group II (n = 12) and Group III (n = 12) were repaired via transperitoneal approach with bowel packed within the peritoneal cavity or exteriorised in a bowel bag respectively. Gastric emptying was measured pre-operatively (day 0), day 1 and day 3 using paracetamol absorption test (PAT) and area under curve (P_AUC) was calculated. Intestinal permeability was measured using the Lactulose-Mannitol test. Results: Aneurysm size, operation time and PAT (on day 0 and day 3) were similar in the three groups. On day 1, the P_AUC was significantly higher in Group I, when compared with Group II and Group III (P = .02). Resumption of diet was also significantly earlier in Group I as compared to Group II and Group III. The intestinal permeability was significantly increased in Group II and Group III at day 1 when compared with day 0, with no significant increase in Group I. Retroperitoneal repair was also associated with significantly shorter intensive care unit (P = .04) and hospital stay (P = .047), when compared with the combined transperitoneal repair group (Group II and III). Conclusion: Retroperitoneal AAA repair minimises intestinal dysfunction and may lead to quicker patient recovery when compared to transperitoneal repair.

Key Words: aortic aneurysm • retroperitoneal • transperitoneal • gastric emptying • bowel dysfunction • paracetamol

This version was published on June 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 3, 262-270 (2009)
DOI: 10.1177/1538574408330400


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