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Kranz J, Grundl S, Wußow F, Steffens J, Anheuser P, Schneidewind L. Permanent Flank Bulge after Flank Incision: Patient- and Physician-Reported Outcome. Urol Int 2021; 106:387-396. [PMID: 34284406 DOI: 10.1159/000517288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to determine the incidence and risk factors for postoperative flank bulging and associated physiologic/psychologic consequences as well as to establish a clinical flank bulge classification system after open retroperitoneal surgery. METHODS In this retrospective study, a postal patient survey was sent to 240 patients who underwent open retroperitoneal surgery between 2007 and 2017. Patients, who reported a flank bulge, were invited for further evaluation, which included a clinical examination and standardized photo documentation. RESULTS Forty-three of 120 patients (35.8%) reported a flank bulging after retroperitoneal surgery. During clinical examination, a flank bulge could be confirmed in 25 patients, whereas in 18 patients, no bulging could be detected, leading to a corrected rate of flank bulge-positive patients of 20.8%. The corresponding relaxation values ranged from 1 to 1.44 and correlated with the clinical degree of bulging. A body mass index of ≥25 was identified as a risk factor. No correlation was found regarding age, gender, surgery side, access to the retroperitoneum, surgical procedure, and pathology. Thirty-seven patients complained about chronic pain or suffered from the cosmetic impact of bulging. Thirteen of those patients had shown a flank bulge during clinical examination, resulting in a symptomatic bulge rate of 10.8% (13/120 patients). CONCLUSION Chronic pain and postoperative flank bulging are 2 of the most common long-term complications after open retroperitoneal access. If an open retroperitoneal approach is required, particularly obese patients should be thoroughly informed about the risk of flank bulging and chronic pain.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany.,Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle, Germany
| | - Sebastian Grundl
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany
| | - Friederike Wußow
- Department of Obstetrics, Bethlehem Health Center gGmbH, Stolberg, Germany
| | - Joachim Steffens
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Laila Schneidewind
- Department of Urology, University Medical Center Rostock, Rostock, Germany
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Chevillotte T, Bordet M, Millon A, Silvestre C, Tresson P. Comment and questions on "Technical approach, outcomes, and exposure-related complications in patients undergoing anterior lumbar interbody fusion". J Vasc Surg 2021; 74:349. [PMID: 34172201 DOI: 10.1016/j.jvs.2021.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Thomas Chevillotte
- Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, Lyon, France
| | - Marine Bordet
- Department of Vascular and Endovascular Surgery, Hopital Louis Pradel, Bron Cedex, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Hopital Louis Pradel, Bron Cedex, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Clément Silvestre
- Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, Lyon, France
| | - Philippe Tresson
- Department of Vascular and Endovascular Surgery, Hopital Louis Pradel, Bron Cedex, France
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Chow AK, Wahba BM, Phillips T, Sands KG, Vetter J, Venkatesh R, Kim EH, Bhayani SB, Figenshau RS. Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center. J Endourol 2021; 35:1639-1643. [PMID: 33820472 DOI: 10.1089/end.2020.0726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Herein we evaluate the incidence of incisional lumbodorsal hernia (ILDH) after retroperitoneal robotic partial nephrectomy (RRPN) and associated patient-specific and tumor-specific risk factors. Furthermore, we aim to evaluate the role of routine lumbodorsal fascial closure for the prevention of ILDH. Methodology: This is a retrospective review of our robotic partial nephrectomy database of all RRPNs performed at Washington University School of Medicine from 2000 to 2020. Postoperative imaging was reviewed for evidence of ILDH. A clinically significant hernia was defined as the protrusion of visceral organ(s) through the lumbodorsal fascia. Patient and tumor characteristics, and fascial closure techniques were analyzed to determine predictors of ILDH. Results: In total, 150 patients underwent RRPN between 2007 and 2020 with an average follow-up of 4.9 (1-37) months. Twelve (8%) ILDHs were identified. Ten (6.7%) patients had herniated retroperitoneal fat whereas 2 (1.3%) patients had herniated colon. All were asymptomatic and managed conservatively. On matched cohort comparison, patients with ILDH had larger tumors than patients without an incisional hernia (3.9 cm vs 2.8 cm, p = 0.029). In general, patient factors were no different between patients with and without ILDH. However, coronary artery disease (CAD) was more prevalent in patients with ILDH (33.3% vs 10.9%, p = 0.028). Patients with ILDH were more likely to have a port site extended for specimen extraction (66.7% vs 38.2%, p = 0.069). Lumbodorsal fascial closure and type of suture material were not associated with prevention of ILDH (p = 0.545, p = 0.637). Conclusion: The radiographic incidence of lumbar incisional hernias after RRPN without routine fascial closure of the extraction incision was 8%. All were asymptomatic and did not require surgical repair. Larger tumor size and CAD were associated with ILDH.
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Affiliation(s)
- Alexander K Chow
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brandon Malik Wahba
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tarik Phillips
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth G Sands
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Inkiläinen A, Blomqvist L, Ljungberg B, Strigård K. Patient-reported outcome measures of abdominal wall morbidity after flank incision for open partial nephrectomy. BJU Int 2021; 128:497-503. [PMID: 33825298 DOI: 10.1111/bju.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures in patients with and without abdominal wall complications after open partial nephrectomy (OPN) via flank incision. PATIENTS AND METHODS Patient-reported outcome measures were collected in 2017 from all patients operated on with OPN via flank incision between 2004 and 2016 in Västerbotten County, Sweden. Patients were mailed the ventral hernia pain questionnaire (VHPQ) and an abdominal wall asymmetry (AWA) questionnaire to evaluate postoperative AWA, attributed to bulge or incisional hernia. Demographic and follow-up data were retrieved from patient records. RESULTS A total of 198 patients were eligible for the study, and 146 questionnaires were returned (74%). Forty-five patients (31%) reported postoperative AWA and 27 (18%) reported ongoing pain. Three patients who reported AWA had a known incisional hernia. Pain and abdominal wall stiffness were more common in patients with AWA than in those without (P < 0.01 and P < 0.01, respectively). Of the 45 patients with AWA, 25 (56%) reported this as being negative cosmetically and 16 (36%) as negative regarding activities. Patients that reported AWA were younger and had a higher body mass index at surgery (P = 0.03 and 0.04, respectively). CONCLUSION Abdominal wall asymmetry is a common sequel of flank incision for OPN and is associated with a higher incidence of chronic pain and abdominal stiffness compared to absence of postoperative AWA. Some patients reported that the effect on daily activities and the cosmetic effect caused by AWA had a negative impact on their quality of life.
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Affiliation(s)
- Aapo Inkiläinen
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Kriegmair MC, Younsi N, Hiller K, Leitsmann C, Kowalewski KF, Siegel F, Rothamel M, Ritter M, Bolenz C, Kriegmair M, Trojan L, Michel MS. Single- vs multiple-layer wound closure for flank incisions: results of a prospective, randomised, double-blinded multicentre study. BJU Int 2020; 127:64-70. [PMID: 32564459 DOI: 10.1111/bju.15148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the incidence of postoperative flank bulges between patients with multiple-layer closure and single superficial-layer closure after retroperitoneal surgery via open flank incision in the SIngle versus MUltiple-LAyer wound Closure for flank incision (SIMULAC) trial. PATIENTS AND METHODS The study was a randomised controlled, patient- and assessor-blinded, multicentre trial. Between May 2015 and February 2017, 225 patients undergoing flank incisions were randomised 1:1 to a multiple-layer closure (SIMULAC-I) or a single superficial-layer closure (SIMULAC-II) group. The primary outcome was the occurrence of a flank bulge 6 months after surgery. RESULTS Overall, 177 patients (90 in SIMULAC-I, 87 in SIMULAC-II) were eligible for final assessment. The cumulative incidence of a flank bulge was significantly higher in the SIMULAC-II group (51.7%) compared to the SIMULAC-I group [34.4%; odds ratio (OR) 2.04, 95% confidence interval (CI) 1.11-3.73; P = 0.02]. Rate of severe postoperative complications (4.4% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.21) or hernia (6.7% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.59) was similar between the groups. There was no difference in pain (visual analogue scale) and the requirement for pain medication at 6 months postoperatively. Quality of life assessed with the European Quality of Life 5 Dimensions Questionnaire was higher in the SIMULAC-I group compared to the SIMULAC-II group at 6 months postoperatively, with a (median range) score of 80 (30-100) vs 75 (5-100) (P = 0.012). CONCLUSION The overall risk of a flank bulge after flank incision is high. Multiple-layer closure after flank incision should be performed as a standard procedure.
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Affiliation(s)
| | - Nina Younsi
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Kiriaki Hiller
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Conrad Leitsmann
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Karl F Kowalewski
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | | | - Manuel Ritter
- Department of Urology, University of Bonn, Bonn, Germany
| | | | | | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
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van Schaik J, van der Vorst JR, Hamming JF, Elzevier HW, Nicolai MPJ. Vascular Surgeons' Views on Ejaculation Disorders After Abdominal Aortic Surgery: Results of a Dutch Survey. Ann Vasc Surg 2020; 67:346-353. [PMID: 32247063 DOI: 10.1016/j.avsg.2020.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/04/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study is to evaluate vascular surgeons' knowledge and appreciation of ejaculatory dysfunction after open aortic aneurysm repair and the knowledge of possible nerve-preserving techniques. METHODS A Dutch national survey was conducted on sexual counseling in the case of open aortic surgery. For this purpose, a designed questionnaire based on a review of the literature in the field and on other surveys aiming to analyze care for sexual health by medical specialists was used. RESULTS The response rate was almost 60%. All responders were familiar with the occurrence of postoperative neurogenic complications. Sixty percent preoperatively informs their patients, but only one-third inquires whether such complications have occurred postoperatively. Most respondents estimated the incidence of postoperative neurogenic complications due to dissection of the periaortic tissues between 5% and 25%. Almost 75% take nerve anatomy into consideration when exposing the abdominal aorta, but only 29% mention the correct structures, and only 37% mention possible correct nerve-sparing techniques. CONCLUSIONS Dutch vascular surgeons are well aware of the occurrence of postoperative sexual disorders after infrarenal aortic reconstruction. A gap in knowledge of pathophysiology and anatomy exists. Furthermore, a significant part of vascular surgeons seems to lack skills in sexual counseling. Therefore, more education should be offered during vascular surgical training. WHAT THIS ARTICLE ADDS This article addresses iatrogenic neurogenic complications affecting sexual health following open aortic surgery. It opens the discussion on possible gaps in modern training of vascular surgeons and on sexual health in relation to postoperative quality of life and shared decision-making.
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Affiliation(s)
- Jan van Schaik
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Joost R van der Vorst
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Henk W Elzevier
- Department of Urology, Leiden University Medical Centre, Leiden, the Netherlands
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Kudo T. Surgical Complications after Open Abdominal Aortic Aneurysm Repair: Intestinal Ischemia, Buttock Claudication and Sexual Dysfunction. Ann Vasc Dis 2019; 12:157-162. [PMID: 31275467 PMCID: PMC6600101 DOI: 10.3400/avd.ra.19-00038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While surgical treatment for abdominal aortic aneurysm (AAA) is a standard operation, prevention of complication is important. Intestinal ischemia of the sigmoid colon and/or rectum after AAA surgery is severe and has a high mortality rate although occurrence frequency is low. The most important thing to prevent is the preoperative and intraoperative evaluation of the left hemicolon and rectal circulation. Measurement of inferior mesenteric artery stump pressure is also useful. From the viewpoint of prevention of buttock claudication, it is desirable that internal iliac artery (IIA) blood flow is preserved, but aggressive IIA reconstruction adaptation is considered to be low. For erectile function, it is important that the antegrade blood flow from the IIA to the internal pudendal artery on at least one side is preserved or reconstructed. To prevent retrograde ejaculation, it is important to preserve the superior hypogastric plexus and one side of the lumbar splanchnic nerve, and the hypogastric nerve. Understanding and mastering local anatomy and pathophysiology is important in preventing complications, and we must also remember that we always keep watchful surgical operations in mind in order to prevent tissue damage. (This is a translation of Jpn J Vasc Surg 2019; 28: 99-103.).
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Affiliation(s)
- Toshifumi Kudo
- Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
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Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 873] [Impact Index Per Article: 174.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Sexual Dysfunction After Abdominal Aortic Aneurysm Surgical Repair: Current Knowledge and Future Directions. Eur J Vasc Endovasc Surg 2018; 55:267-280. [DOI: 10.1016/j.ejvs.2017.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/27/2017] [Indexed: 12/26/2022]
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Zhou DJ, Carlson MA. Incidence, etiology, management, and outcomes of flank hernia: review of published data. Hernia 2018; 22:353-361. [DOI: 10.1007/s10029-018-1740-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/19/2018] [Indexed: 11/24/2022]
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Seyam R. A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men. Ther Adv Urol 2013; 5:254-97. [PMID: 24082920 DOI: 10.1177/1756287213497231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed. OBJECTIVES The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports. METHODS A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded. RESULTS A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options. CONCLUSION There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions.
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Affiliation(s)
- Raouf Seyam
- King Faisal Specialist Hospital and Research Center, PO Box 3354, MBC 83, Riyadh 11211, Saudi Arabia
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Fahim DK, Kim SD, Cho D, Lee S, Kim DH. Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation. J Neurosurg Spine 2011; 15:532-40. [DOI: 10.3171/2011.7.spine10887] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The thoracolumbar junction is frequently accessed through an anterolateral approach with the incision and muscle dissection extending from the lower thoracic region to the lateral border of the rectus abdominis muscle. This approach is frequently associated with the subsequent development of an unsightly and uncomfortable relaxation of the ipsilateral abdominal wall, or flank bulge, caused by denervation injury to the intercostal nerves. However, the etiology of this complication is not widely recognized by spine surgeons. The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature.
Methods
The authors performed 32 cadaveric dissections and 6 intraoperative electromyography (EMG) evaluations.
Results
The cadaveric dissection studies and intraoperative EMG evaluations provided detailed anatomy of the anterolateral abdominal wall and its innervation. Cadaveric dissections revealed that the most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12. Electrophysiological confirmation of these findings was accomplished through intraoperative stimulation in 6 patients undergoing anterolateral retroperitoneal approaches to the thoracolumbar junction. The authors confirmed T11 and T12 innervation of the anterolateral abdominal wall musculature by direct intraoperative EMG recording in all 6 patients.
Conclusions
The authors classified the 3 potential zones of injury that can be affected during an anterolateral approach to the thoracolumbar junction. Modifications to the operative technique are suggested to avoid the complication of flank bulge. The most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12.
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Affiliation(s)
- Daniel K. Fahim
- 1Department of Neurosurgery, Baylor College of Medicine
- 2St. Luke's Neuroscience Center, Houston, Texas
- 3Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Sang Don Kim
- 1Department of Neurosurgery, Baylor College of Medicine
- 4Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon; and
| | - Dosang Cho
- 1Department of Neurosurgery, Baylor College of Medicine
- 5Department of Neurosurgery, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Sangkook Lee
- 1Department of Neurosurgery, Baylor College of Medicine
| | - Daniel H. Kim
- 1Department of Neurosurgery, Baylor College of Medicine
- 2St. Luke's Neuroscience Center, Houston, Texas
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Borkon MJ, Zaydfudim V, Carey CD, Brophy CM, Guzman RJ, Dattilo JB. Retroperitoneal repair of abdominal aortic aneurysms offers postoperative benefits to male patients in the Veterans Affairs Health System. Ann Vasc Surg 2010; 24:728-32. [PMID: 20471791 DOI: 10.1016/j.avsg.2010.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 10/26/2009] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Transperitoneal (TP) and retroperitoneal (RP) approaches have equal efficacy in elective open abdominal aortic aneurysm (AAA) repair. The effect of open operative approach on patient-specific outcomes after AAA repair was tested. METHODS Consecutive patients undergoing open AAA repair at the Veterans Affairs Tennessee Valley Healthcare System between January 2000 and August 2008 were retrospectively reviewed. Analysis was performed to examine the effects of demographic and clinical covariates on postoperative outcomes. RESULTS A total of 106 patients were identified: 54 with TP approach and 52 with RP approach. Demographics and preoperative comorbidities were equivalent (p > or = 0.10), with the exception of chronic obstructive pulmonary disease which was more prevalent in the TP group (61 vs. 40%). Operative times were longer in the TP group (4.6 vs. 3.5 hours; p < 0.01); however, significantly more TP patients had reconstruction with a bifurcated graft (72 vs. 2%; p < 0.01). Postoperative nasogastric tube decompression times were shorter in the RP group (1 vs. 3 days; p < 0.01), and RP approach led to a quicker return to preoperative diet (4 vs. 6 days; p = 0.05). Patients undergoing RP repair developed fewer incisional hernias (2 vs. 15%; p = 0.03). CONCLUSION RP approach to AAA repair offers patients faster return of bowel function and is associated with fewer incisional hernias.
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Affiliation(s)
- Matthew J Borkon
- Department of Surgery, Tennessee Valley Healthcare System, Nashville Campus, Nashville, TN, USA
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¿Existen ventajas en el abordaje extraperitoneal para el tratamiento del aneurisma de aorta abdominal? REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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San Norberto-García E, Revilla-Calaria A, Gutiérrez-Alonso V, Martín-Pedrosa M, Cenizo-Revuelta N, Vaquero-Puerta. C. Disfunción sexual tras la reparación endovascular del aneurisma de aorta abdominal infrarrenal. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)16004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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