Transperitoneal
Retroperitoneal
Transperitoneal
Advantages
Most rapid, greatest flexibility
Provides widest access
Enables evaluation of intra-abdominal pathology
Disadvantages
Longer ileus
Potential for greater fluid losses
Difficulty with exposure and control for juxta – or pararenal AAA
Retroperitoneal
Advantages
Avoids hostile abdomen
Facilitates exposure and control for juxta-pararenal AAA
Potential for less ileus, other physiologic stress
Obesity
Inflammatory AAA/horseshoe kidney
Disadvantages
Poor access to right renal and iliac arteries
Cannot evaluate intra-abdominal pathology
Longer to open and close
More flank bulges, chronic wound pain

AAA, Abdominal aortic aneurysm.