Introduction: The adequate exposure of the upper abdominal aorta and its side branches are essential for vascular reconstruction of this region. Besides the traditional transperitoneal, retroperitoneal approach or thoracolaparotomy, left medial visceral rotation (MVR) is an option to explore this hardly accessible region. We present our MVR experiences in aortic surgery.
Methods: Using median or subcostal laparotomy we mobilised the left colon, the spleen, the pancreas and performed dissection in the retroperitoneal area leaving the left kidney in place. The indications of surgery were suprarenal aneurysm in one case, extensively calcified aortic atherosclerosis causing significant stenosis in three cases, postoperative anastomotic pseudoaneurysm in one case and type B aortic dissection causing malperfusion in one case. We performed two thrombendarterectomies (TEA), one TEA with aortobifemoral bypass grafting, two aortic interposition with dacron prosthesis and cryopreserved homograft and one aortic refenestration.
Results: the median age was 58 years (43-72). The average operation time was 231 ± 80 minutes, average supraceliac crossclamping time was 43 ± 15 minutes. We used cell saver in three cases. Average hospital stay was 16.16 ± 13.53 days. One patient suffered spleen capsule injury requiring splenectomy and 2 patients had reoperation because of bleeding. Two patients developed renal failure, one of them required long-term dialysis. No death, pancreatitis or bowel necrosis occurred.
Conclusions: Based on trauma experience, transabdominal medial visceral rotation provides a good exposure for acute or elective vascular reconstruction of the upper abdominal aortic segment. The intraoperative bleeding control, the approach of the distal part of visceral arteries is more accessible using laparotomy and lateral aortic exploration. The thoracolaparotomy with opening of two body cavities causes higher morbidity, mainly pulmonary complications. Further advantage of MVR is the direct access of abdominal organs and its vessels. During surgery the lesions of parenchymal organs (spleen, pancreas), the intestine and the compression of mesenterium must be avoided.
Keywords: medial visceral rotation; medialis visceralis rotáció; suprarenal aorta; suprarenalis aorta.