Minimal incision approach for abdominal aortic aneurysm (AAA) repair

Comparison of Transperitoneal and Retroperitoneal Approaches in Abdominal Aortic Surgery

“…This, however, did not prolong the length of hospital stay. Our finding confirmed previous reports (1,14,23,24), as RP incision has frequently been reported to cause postoperative wound complicatons. This has been attributed to the injury caused to the neurovascular segments by muscle division during the operative procedure which results in muscle atrophy, subsequently leading to the development of incisional hernia and wound bulging (15).…”

Systematic Review and Meta-analysis of the Retroperitoneal versus the Transperitoneal Approach to the Abdominal Aorta

“…15,18 One randomised study was powered, and this was not for outcomes used in this meta-analysis. 18 Many studies did not clearly state length of follow up, 15e17,19,25e 31,35,36,42 however as the majority of outcomes metaanalysed were short term, follow up was considered appropriate if 30 day mortality was reported. Studies reporting wound herniation and 1 year follow up lost a quality point for not stating follow up or reporting outcomes until at least a year.…”

“…Studies reporting wound herniation and 1 year follow up lost a quality point for not stating follow up or reporting outcomes until at least a year. 24,25,31,40,42 GRADE quality assessment is shown in Table 2. The quality of the evidence presented for each outcome was either 'low' or 'moderate.'…”

“…There was no difference on meta-analysis for rates of myocardial infarction from 12 studies, 5,15,16,21,23,30e33,36,37,42 renal failure from 15 studies, 5,16,21,23,25e30,32,33,37,41,42 and wound hernia from 8 studies. 21,24,25,31,33,34,40,42 However, renal failure was significantly lower for RP patients on high quality sensitivity analysis (OR 0.61 [0.37, 1.00], p ¼ 0.05). Table 5 shows mortality and length of stay outcomes.…”

“…Intensive care stay was significantly lower in the RP group in six of 14 studies, 20,23,24,28,32,41 with the remaining 8 showing a non-significant trend towards a shorter stay in the RP group (Table 6). 5,15,21,22,25,31,33,37 This translated to a significantly shorter ICU stay in RP patients on meta-analysis (SMD À0.67…”