Abdominal aortic laparoscopic surgery: Retroperitoneal or transperitoneal approach?

Objective: to define the respective advantages and pitfalls of the trans- o r retroperitoneal approaches in laparoscopic abdominal aortic reconstructio n (LAOR). Design: prospective study. Material: ten patients (8 makes; average age 58) underwent an aortouni- (n = 2) or bifemoral bypass (n = 8) to treat occlusive disease (n = 8) or an a ortic aneurysm (n = 2). Methods: a retrospective approach (the "apron" technique) was used in the l ast 5 cases (Group I) and a transperitoneal approach in the last 5 cases (G roup II). Results: no early or late death occurred, and all bypasses remain patent af ter a mean follow-up of 5.7 months. Mean surgical and clamping times are si milar in both groups (370 and 126 min Group 1; 324 and 137 min in Group II) . One intraoperative conversion to open surgery and two postoperative surgi cal complications occurred in Group I. Four minilaparotomies 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 patien ts were discharged on postoperative day 6 in Group I and five in Group II. Conclusion: this preliminary study shows the feasibility of LAOR through bo th 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 a rtery was not always necessary.