Abdominal aortic laparoscopic surgery: Retroperitoneal or transperitoneal approach?

Objective: 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 makes; average age 58) underwent an aortouni- (n = 2) or bifemoral bypass (n = 8) to treat occlusive disease (n = 8) or an aortic aneurysm (n = 2). Methods: a retrospective approach (the "apron" technique) was used in the last 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 Group 1; 324 and 137 min in Group II). One intraoperative conversion to open surgery and two postoperative surgical 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 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.