Transabdominal open abdominal aortic aneurysm repair is associated with higher rates of late reintervention and readmission compared with the retroperitoneal approach

Abstract

Objective: Limited data exist comparing the transabdominal and retroperitoneal approaches to open abdominal aortic aneurysm (AAA) repair, especially late mortality and laparotomy-related reinterventions and readmissions. Therefore, we compared long-term rates of mortality, reintervention, and readmission after open AAA repair through a transabdominal compared with a retroperitoneal approach. Methods: We identified all patients in the Vascular Quality Initiative (VQI) undergoing open AAA repair from 2003 to 2015.Patients with rupture or supraceliac clamp were excluded. We used the VQI linkage to Medicare to ascertain rates

There is no more wound complications with transabdominal open abdominal aortic aneurysm repair compared with the retroperitoneal approach

“…The use of mesh reinforcement reduced this risk to 16% (P < .004). Also, we believe that the rate of incisional hernias is much higher than the 13% noted in the study reported by Deery et al 1 Moreover, the retroperitoneal approach through an oblique incision can result in two different complications. It could result in a true hernia but could also result in a bulge, which is a myofascial laxity without defects.…”

“…We read with a great interest the article from Derry et al 1 In their study, the 5-year rate of laparotomy-related reinterventions was greater after the transabdominal approach than after the retroperitoneal approach (13% vs 6.1%). These results would, therefore, encourage favoring the retroperitoneal approach.…”

“…4 Finally, the mean follow-up of the study was not specified. 1 A 36-month follow-up has been recommended in the guidelines from the European Hernia Society. 5 Previous studies have shown that the cumulative hernia incidence increases continuously for #7 years after the operation, suggesting that patients with abdominal aortic aneurysms should be followed up for longer.…”

Reply

“…We appreciate your comments regarding our study evaluating outcomes after open abdominal aortic aneurysm (AAA) repair using a retroperitoneal vs transabdominal approach. 1 In our study of Medicare beneficiaries, patients who underwent transabdominal AAA repair had higher rates of repair-related readmissions and reinterventions compared with patients who underwent a retroperitoneal approach at 5 years (42% vs 34%), and this was driven primarily by higher rates of hernia repairs (13% vs 6.1%; P < .01). As suggested in the above letter, these numbers do not account for all hernias or abdominal wall bulges, but only those who ultimately underwent intervention.…”

Pelvic radiation therapy as a potential risk factor for ischemic colitis complicating abdominal aortic reconstruction

“…With an open surgical approach, poorer outcomes occur with transabdominal access (which we used). 10 The reimplantation of the IMA was rejected because of the critical stenosis at the origin and a 2-mm diameter along the entire length.…”