Retroperitoneal Aortic Aneurysm Repair: Long-Term Follow-Up Regarding Wound Complications and Erectile Dysfunction

Abstract

The long-term impact of retroperitoneal aortic exposure regarding wound complications in all patients and erectile dysfunction in men was studied in a consecutive group of 107 patients (81 males and 26 females). Postoperative wound complications were classified into the following groups: none, flank bulge, hernia, and chronic pain. Patient demographic features including body mass index (BMI) were statistically analyzed in relation to the incidence of long-term wound problems. Information regarding erectile dysfunction was obtained before surgery in all men and stratified into three groups after surgery: no change, inability to consistently obtain an erection, and retrograde ejaculation. Mean patient follow-up was 2.9 years (range 1-4.36, median 2.8). Flank bulge was the only long-term wound complication, and this was noted in nine patients (8%). The incidence of true hernia and chronic pain was 0%. BMI >28 was the only factor that positively impacted the incidence of wound complications (p < 0.0001). Erectile dysfunction prior to surgery was noted in 37 men (46%), while 44 (54%) reported normal erectile function. Erectile function improved after surgery in one patient but remained unchanged in the rest. Postoperative retrograde ejaculation occurred with a frequency of 9% (four of 45 patients). Retroperitoneal abdominal aortic aneurysm (rAAA) exposure with incision based on the twelfth rib tip and rectus abdominis muscle sparing results in an overall low incidence of long-term wound complications. Postoperative flank bulge is associated with patient BMI >28. In addition, erectile function is not worsened by infrarenal autonomic nerve sparing rAAA exposure. However, a small percentage of potent men will experience postoperative retrograde ejaculation.