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

Jeffrey L. Ballard, MD, St. Joseph Hospital of Orange, Orange, CA; Ahmed M. Abou-Zamzam,Jr., MD, Loma Linda, CA; Theodore H. Teruya, MD, Honolulu, HI; Timothy R.S. Harward, MD, Orange, CA; D. Preston Flanigan, MD, Orange, CA;

Purpose: One hundred seven consecutive patients (81 males, 26 females) had elective retroperitoneal abdominal aortic aneurysm (rAAA) repair at a single institution from 10/2000 to 05/2003. These patients participated in a quality of life study that has been previously published. At this time, we specifically examine the long-term impact of rAAA exposure regarding wound complications in all patients and erectile dysfunction (ED) in men.
Methods: All patients were clinically examined at least one year after surgery. Further long-term follow-up was achieved either clinically or via telephone interview. Mean patient follow-up was 2.9 years with range 1 to 4.36 years and median 2.8 years. 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 ED was obtained before surgery in all men and was then stratified into three groups after surgery: no change, inability to consistently obtain an erection and retrograde ejaculation. These data are presented using statistical analysis of frequencies and chi square analysis.
Results: Flank bulge was the only long-term wound complication and this was noted in 9 patients (8%). The incidence of true hernia and chronic pain was 0%. Ninety-eight patients (92%) were free of wound problems at latest follow-up. BMI >28 was the only factor that was significantly related to the incidence of wound complications (p <0.0001). ED prior to surgery was noted in 37 men (46%) and 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% (4 of 45 patients).
Conclusions: rAAA exposure with incision based on the 12th 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, nearly 50% of men presenting for aneurysm repair have ED and erectile function is not significantly impacted by infrarenal sympathetic nerve sparing rAAA exposure. However, a small percentage of potent men will experience postoperative retrograde ejaculation.