Original Jpn. J. Vasc. Surg., 12:55-59, 2003 
Midline Skin Incision and Right Extraperitoneal Approach for Abdominal Aortic Aneurysm
Masamitsu Endo,1 Ikuko Kosugi,1 Fuminori Kasashima,1 Yoshinobu Abe,1 Yasushi Matsumoto,2 and Hisao Sasaki2
1 Department of Cardiovascular Surgery, National Kanazawa Hospital
2 Clinical Research Center, National Kanazawa Hospital

This study was conducted to compare the midline incision right extraperitoneal approach with the transperitoneal approach for repairing abdominal aortic aneurysms (AAA). We compared the intra- and postoperative time course between 35 patients who underwent AAA repair using the transperitoneal approach and 105 AAA patients with the extraperitoneal method. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer time was required from the skin incision to aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, the total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of post-operative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as incisional hernia and/or bulge associated with the left flank incision developed. Thus we recommend the midline incision right extraperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications.

Key words:
Abdominal aortic aneurysm, Extraperitoneal approach, Midline skin incision, Right side approach, Wound complications