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There are two main types of incisions or approaches used in open repair of AAA. These are long midline incision for transperitoneal approach and oblique flank incision for retroperitoneal approach. The third type of incision used is the upper abdominal transverse incision and it can be used for both the approaches.
Both the approaches have their own advantages and disadvantages. The transperitoneal approach is most commonly used. It provides the greatest amount of flexibility during surgery and greatest amount of exposure of aortic aneurysm and renal, iliac and femoral arteries. But this approach is difficult when the patient has a history of abdominal surgery or there is suprarenal extension of the disease. It cannot be used in the case of horseshoe kidneys, ascites and peritoneal dialysis.
Retroperitoneal approach can completely avoid intraperitoneal structures and can be used when there are peritoneal adhesions and severe pulmonary disease and intestinal stoma is present. This can also be used when greater suprarenal exposure is required. There are also less complications associated with retroperitoneal approach. Patients have a shorter postoperative stay in the hospital, duration of postoperative ileus is less, pulmonary complications are less frequent and the stay in ICU is also shorter. The disadvantage of retroperitoneal approach is that it leads to difficulty in accessibility of right iliac and renal arteries.
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