Intraabdominal Nonvascular Operations Combined with Abdominal Aortic Aneurysm Repair

Abstract

The therapeutic approach to a patient who has an abdominal aortic aneurysm (AAA) and an intraabdominal nonvascular surgical disorder simultaneously remains controversial. To establish guidelines for the management of those patients, a retrospective review of patients who had concomitant AAA and intraabdominal nonvascular surgical disorders was undertaken. During the period January 1988 to December 1997 a series of 162 patients underwent surgical repairs of AAA in our hospital. Among them 16 patients (9.9%) had several kinds of intraabdominal nonvascular surgical disorders, and 13 underwent one-stage operation for both diseases. That is, cholelithiasis coexisted in five patients, inguinal hernia in four, gastric cancer in two, and retroperitoneal tumor and renal tumor in one each. All AAAs were the infrarenal type, and there were no inflammatory or ruptured aneurysms. In cases of cholelithiasis coexistent with AAA, aneurysmectomy was performed first. After tight closure of the retroperitoneum, cholecystectomy was done. In cases of cholelithiasis coexistent with AAA, aneurysmectomy was performed first. After tight closure of the retroperitoneum, cholecystectomy was done. In cases of inguinal hernia coexistent with AAA, the AAA was first replaced with a prosthetic vascular graft and a residual piece of the graft was used as a patch for hernioplasty. This procedure was similar to laparoscopic hernioplasty. In two cases of gastric cancer concomitant with AAA, the AAA was first replaced. Subtotal gastrectomy with D2 lymphatic dissection was done after tight closure of the retroperitoneum. A drain was inserted into the epiploic foramen to detect anastomotic leakage. A retroperitoneal tumor coexisting with AAA was dissected and resected en bloc with the aneurysmal wall because the tumor firmly adhered to the aneurysm. The abdominal aorta was then replaced with a prosthetic graft. In a case of renal tumor concomitant with AAA, nephrectomy was done first to perform a complete lymphatic dissection around the renal artery. Then AAA repair was performed with a conventional procedure. There were no fatal complications, such as pneumonitis, hemorrhage, anastomotic leakage, or graft infection. All 13 patients were discharged from our hospital and are currently free from recurrence of malignancy or hernia. In summary, properly selected one-stage operations for intraabdominal nonvascular surgical disorders and AAA may be safe and bring physical and economic benefit to the patient.

Simultaneous total gastrectomy and endovascular repair of an abdominal aortic aneurysm: Report of a case

“…[14][15][16][17][18][19][20] Similarly, when dealing with AAA-associated gastric cancer in low-risk patients, concomitant subtotal or total gastrectomy can safely be performed in combination with open AAA repair. 11 However, to our knowledge there have not been any reports describing either a concomitant subtotal or total gastrectomy in a high-risk patient with AAA.…”

Simultaneous Orthotopic Liver and Kidney Transplant with Repair of Abdominal Aortic Aneurysm: Operative Timing

“…The question was whether to repair first the AAA aneurysm and perform the double transplantation at a later time, or to perform all three procedures in the same operative session. The argument against the first option is that the repair of an AAA in a patient affected by end-stage liver and kidney disease carries a higher risk of mortality and morbidity than in patients affected only by AAA (17)(18)(19). Moreover, the use of a vascular prosthesis could be associated with the potential risk of infection during the subsequent transplant procedures or later as a result of the immunosuppressive therapy (20).…”

Koinzidenz eines Bauchaortenaneurysmas mit Pathologien viszeraler Hohlorgane

“…Nun ist ein Trend hin zum einzeitigen Vorgehen auszumachen. Nachdem bereits Ochsner et al [17] dieses Vorgehen 1960 erstmals vorgestellt hatte, unterstützen nun mehrere, vor allem japanische Autoren diese Strategie, wobei vergleichbare Ergebnisse ausgewiesen werden [10,13,25].Eine Protheseninfektion wurde von keinem der genannten Autoren beschrieben. Nebst der Vermeidung eines Zweiteingriffes, der verkürz-ten Hospitalisationszeit und der damit in geringerem Maße anfallenden Kosten wird von Seiten der Protagonisten eines einzeitigen Verfahrens auch die Vermeidung einer Aufschiebung einer dringlichen Operation als hauptsächliche Vorteile genannt.…”