ABSTRACT
BACKGROUND: To compare retroperitoneal (RP) vs. transperitoneal (TP) approaches in abdominal aorta reconstruction in terms of operative characteristics, plasma interleukin-10 levels and postoperative complications. METHODS: A total of 100 patients scheduled for elective abdominal aortic surgery for occlusive disease under general anesthesia from May 2005 to January 2010 were included in this prospective study with allocation of patients randomly to TP approach (n = 50 ; mean (SD) age : 64.3 (4.0) years ; 76.0% were males) or RP approach (n = 50 ; mean (SD) age : 63.8 (5.6) years ; 75.0% were males) for aortic surgery. Demographic data, risk factors, perioperative and postoperative data and IL-10 levels were analyzed in two groups. RESULTS: TP approach was associated with higher levels for IL-10 measured at the time of T1 (before unclamping of aorta) [(8.4 (5.1) vs. 6.5 (4.9) pg/mL, p < 0.05)] and T2 (sixty minutes after declamping) [(11.7 (6.0) vs. 8.3 (6.2) pg/mL, p < 0.01)] compared with RP approach. Postoperative evaluation revealed a higher percentage of patients with postoperative ileus (10.0 vs. 0.0%, p < 0.001) and pulmonary complications (18.0 vs. 4.0%, p < 0.001) in the TP rather than RP groups. The TP and RP groups were similar in terms of mortality rates whereas TP approach was associated with longer mean (SD) length of hospital stay (6.2 (1.0) vs. 3.8 (1.0) days, p < 0.001) compared with the RP approach. CONCLUSIONS: Our findings revealed that the RP approach has significant advantages over the TP approach in aortic reconstruction surgery leading better pulmonary function and low ileus rate in the postoperative period as well as shorter length of hospital stay. While an increase in IL-10 levels was reported in both approaches, probably in relation to higher degree of tissue trauma, the increase was more profound in the TP approach.
