PMID- 10085395
OWN - NLM
STAT- MEDLINE
DCOM- 19990616
LR  - 20220330
IS  - 0364-2313 (Print)
IS  - 0364-2313 (Linking)
VI  - 23
IP  - 5
DP  - 1999 May
TI  - Intraabdominal nonvascular operations combined with abdominal aortic aneurysm 
      repair.
PG  - 469-74; discussion 474-5
AB  - The therapeutic approach to a patient who has an abdominal aortic aneurysm (AAA) 
      and an intraabdominal nonvascular surgical disorder simultaneously remains 
      controversial. To establish guidelines for the management of those patients, a 
      retrospective review of patients who had concomitant AAA and intraabdominal 
      nonvascular surgical disorders was undertaken. During the period January 1988 to 
      December 1997 a series of 162 patients underwent surgical repairs of AAA in our 
      hospital. Among them 16 patients (9.9%) had several kinds of intraabdominal 
      nonvascular surgical disorders, and 13 underwent one-stage operation for both 
      diseases. That is, cholelithiasis coexisted in five patients, inguinal hernia in 
      four, gastric cancer in two, and retroperitoneal tumor and renal tumor in one 
      each. All AAAs were the infrarenal type, and there were no inflammatory or 
      ruptured aneurysms. In cases of cholelithiasis coexistent with AAA, 
      aneurysmectomy was performed first. After tight closure of the retroperitoneum, 
      cholecystectomy was done. In cases of cholelithiasis coexistent with AAA, 
      aneurysmectomy was performed first. After tight closure of the retroperitoneum, 
      cholecystectomy was done. In cases of inguinal hernia coexistent with AAA, the 
      AAA was first replaced with a prosthetic vascular graft and a residual piece of 
      the graft was used as a patch for hernioplasty. This procedure was similar to 
      laparoscopic hernioplasty. In two cases of gastric cancer concomitant with AAA, 
      the AAA was first replaced. Subtotal gastrectomy with D2 lymphatic dissection was 
      done after tight closure of the retroperitoneum. A drain was inserted into the 
      epiploic foramen to detect anastomotic leakage. A retroperitoneal tumor 
      coexisting with AAA was dissected and resected en bloc with the aneurysmal wall 
      because the tumor firmly adhered to the aneurysm. The abdominal aorta was then 
      replaced with a prosthetic graft. In a case of renal tumor concomitant with AAA, 
      nephrectomy was done first to perform a complete lymphatic dissection around the 
      renal artery. Then AAA repair was performed with a conventional procedure. There 
      were no fatal complications, such as pneumonitis, hemorrhage, anastomotic 
      leakage, or graft infection. All 13 patients were discharged from our hospital 
      and are currently free from recurrence of malignancy or hernia. In summary, 
      properly selected one-stage operations for intraabdominal nonvascular surgical 
      disorders and AAA may be safe and bring physical and economic benefit to the 
      patient.
FAU - Tsuji, Y
AU  - Tsuji Y
AD  - Department of Surgery, Division II, Kobe University School of Medicine, 7-5-2 
      Kusunoki-cho, Chuo-ku, Kobe 650, Japan.
FAU - Watanabe, Y
AU  - Watanabe Y
FAU - Ataka, K
AU  - Ataka K
FAU - Sasada, A
AU  - Sasada A
FAU - Okada, M
AU  - Okada M
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Aneurysm, Abdominal/*complications/*surgery
MH  - Carcinoma, Renal Cell/complications/surgery
MH  - Cholelithiasis/complications/surgery
MH  - Female
MH  - Hernia, Inguinal/complications/surgery
MH  - Humans
MH  - Kidney Neoplasms/complications/surgery
MH  - Male
MH  - Middle Aged
MH  - Peritoneal Neoplasms/complications/surgery
MH  - Retrospective Studies
MH  - Stomach Neoplasms/complications/surgery
MH  - Treatment Outcome
EDAT- 1999/03/23 00:00
MHDA- 1999/03/23 00:01
CRDT- 1999/03/23 00:00
PHST- 1999/03/23 00:00 [pubmed]
PHST- 1999/03/23 00:01 [medline]
PHST- 1999/03/23 00:00 [entrez]
AID - 10.1007/pl00012333 [doi]
PST - ppublish
SO  - World J Surg. 1999 May;23(5):469-74; discussion 474-5. doi: 10.1007/pl00012333.