Abdominal Aortic Laparoscopic Surgery: Retroperitoneal or Transperitoneal Approach?

AbstractObjective to define the respective advantages and pitfalls of the trans- or retroperitoneal approaches in laparoscopic abdominal aortic reconstruction (LAOR). Design prospective study. Material ten patients (8 males; average age 58) underwent an aortouni- (n=2) or bifemoral bypass (n=8) to treat aortoiliac occlusive disease (n=8) or an aortic aneurysm (n=2). Methods a retroperitoneal approach (the “apron” technique) was used in the first 5 cases (Group I) and a transperitoneal approach in the last 5 cases (Group II). Results no early or late death occurred, and all bypasses remain patent after a mean follow-up of 5.7 months. Mean surgical and clamping times are similar in both groups (370 and 126 min in Group I; 324 and 137 min in Group II). One intraoperative conversion to open surgery and two postoperative surgical complications occurred in Group I. Four minilaparotomies of 8–10 cm were necessary in Group II. Two patients were discharged on postoperative day 6 in Group I and five in Group II.Conclusion this preliminary study shows the feasibility of LAOR through both approaches. In Group II, a better exposure of the right aortic wall and of the right iliac axis was noted and division of the inferior mesenteric artery was not always necessary