Pilot Study on Feasibility and Outcome of a Nerve-Preserving Aortoiliac Exposure Technique

Abstract

Dysfunctional ejaculation is a common complication following open aortoiliac aneurysm surgery. It may occur in 49-63% of patients and is caused by iatrogenic damage to the sympathetic lumbar splanchnic nerves (LHN) and superior hypogastric plexus (SHP). A nerve-preserving operative technique based on a unilateral right-sided approach to the abdominal aorta, was implemented in clinical practice. The aim of this pilot study was to establish the safety and feasibility of the technique, and whether a sympathetic pathway and ejaculatory function was preserved.u METHODS: Patients were asked to fill out questionnaires preoperatively, and 6 weeks, 6 months and 9 months postoperatively. The International Index of Erectile Function (IIEF), Cleveland Clinic Incontinence Score (CCIS), Pac-Sym and ICIQ-Mluts were used. Surgeons were asked to complete a technical feasibility questionnaire. Twenty-four patients undergoing aortoiliac aneurysm surgery were included. The nerve-sparing phase of the procedure added an average of 5-10 minutes of operating time and was technically feasible in twenty-two patients. No major complications occurred during nerve-sparing exposure. Fifteen of twenty-four patients were sexually active at some point throughout the study. No postoperative loss of ejaculation was seen in sexually active patients. CCIS, Pac-sym, IIEF and ICIQ-Mluts scores remained similar throughout the study. Nerve-preserving aortoiliac reconstruction surgery is safe and feasible. Ejaculatory function is preserved. Given the low number of patients in the study, further research is needed to provide robust data.