Systematic Review and Meta-analysis of the Retroperitoneal versus the Transperitoneal Approach to the Abdominal Aorta

• Published in: European journal of vascular and endovascular surgery 2013-07, Vol.46 (1), p.36-47
• Main Authors: Twine, C.P, Humphreys, A.K, Williams, I.M
• Format: Article
• Language: English
• Subjects: Abdominal aortic aneurysm; Aortic Aneurysm, Abdominal - surgery; Humans; Meta-analysis; Operative procedures; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retroperitoneal Space; Surgery; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2013.03.018

Objectives The aim was to systematically review and meta-analyse the differences between the retroperitoneal (RP) and the transperitoneal (TP) approach to the infrarenal abdominal aorta. Design Systematic review and meta-analysis. Methods PubMed, the Cochrane library, Embase and ClinicalTrials.gov were searched for all studies on differences in clinical outcomes between the RP and TP approach. Outcomes were selected based on inclusion in two or more studies: Operative (length of procedure, intraoperative blood loss); Post operative complications (paralytic ileus, pneumonia, myocardial infarction (MI), renal failure and wound hernia); Mortality (30 day, 1 year); Post-operative changes in respiratory function (forced expiratory volume in 1 second, forced vital capacity); Length of hospital and Intensive care unit (ICU) stay and Cost. The data were pooled by outcome. Results Eight randomised and 21 cohort studies involving 3035 patients were included. Meta-analysis showed significantly lower rates of postoperative ileus (Odds ratio (OR) 0.17[95% CI 0.10, 0.32] p