Background

There has been a lot of debate in the surgical literature about the best way to surgically access the infrarenal abdominal aorta during an operation to repair an abdominal aortic aneurysm (AAA; a ballooning of an artery (blood vessel) which occurs in the major artery in the abdomen (aorta)). Two approaches are commonly used: the retroperitoneal (RP) approach and the transperitoneal (TP) approach. Both approaches appear to have advantages and disadvantages. Many trials comparing RP and TP aortic surgery have been published with conflicting results. The aim of this Cochrane review is to assess the effectiveness and safety of the TP versus RP approach for planned surgical open AAA repair on mortality, complications, hospital stay and blood loss.

Key results

We included four small randomized controlled trials (RCTs) (129 participants) after we searched the literature up to May 2015). There were no differences between RP and TP for death. Our analysis seems to show a trend that RP might increase the complications such as hematoma (swelling of clotted blood), chronic wound pain and abdominal wall hernia compared with TP but there were variations between the included trials. We found that RP led to lower blood loss, and shorter hospital stay and ICU stay compared with TP but there were no differences between the two approaches for operating time and aortic cross‐clamp time (length of time a surgical instrument, used to clamp the aorta and separate the circulation from the outflow of the heart, is used).

Quality of the evidence

Three of the four included trials had methodological weaknesses, such as unclear randomisation methods, and no reporting of blinding of the people assessing the outcome which compromised the value of their results. In addition, the included trials only included a small number of people, there were few outcomes reported, there was a relatively short follow‐up and there were inconsistencies between the included trials resulting in very low to low quality of the evidence. More large‐scale RCTs of the RP approach versus the TP approach for planned surgical open AAA repair are needed.