Gastrointestinal complications requering reoperation after aorto-iliac reconstructions

Introduction: Major gastrointestinal complications after aorto-iliac surgery are rare but may be disastrous.

Aim: To clear the risk factors and the way of the prevention of these complications.

Patients and methods: From 1996 to 2004 we performed 715 aorto-iliac reconstructions. Aneurysm formation was the indication in 118 cases (24 of them was ruptured), and 597 patients were operated for the occlusive disease of the aorto-iliac segment. If the situation allowed, we made the aorto-bifemoral bypasses through a retroperitoneal approach (24 patients). In 14 cases we made the reimplantation of the inferior mesenteric artery.

Results: The overall postoperative mortality was 4,9%. We performed 11 reoperations (1,54%) for major gastrointestinal complications in the postoperative period. The operation finding was: 3 sigma necroses, 3 intestinal obstructions, 2 disruptions, 1 perforation, 1 abscess and 1 rupture of the spleen. All the patients with bowel necrosis died and all survived with the other gastrointestinal complications. We had two sigma necroses after aneurysm repair and one after aorto-bifemoral bypass. 5 complications occurred after aneurysm repair (4,24%) and 6 after the re-canalization of the aorto-iliac segment (1,0%, p<0,05). After operations performed through a retroperitoneal approach, we had one disruption and one perforation 0,4%, this rate was 4,1% following the transperitoneal interventions (p<0,001).

Conclusion: Complete bowel necrosis after aorto-iliac surgery is usually fatal. The prevention (reimplantation of the inferior mesenteric artery) and early detection of this complication (colonoscopy) is very important. The retroperitoneal approach can reduce the gastrointestinal complications after aorto-iliac reconstructions.