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Early and late outcomes of retroperitoneal thoracophrenolumbotomy healing following open repair of thoracoabdominal aortic aneurysm and mega-aortic syndrome: a 15-year single-center experience

Early and late outcomes of retroperitoneal thoracophrenolumbotomy healing following open repair of thoracoabdominal aortic aneurysm and mega-aortic syndrome: a 15-year single-center experience

Authors:
Эдуард Рафаэлович Чарчян,
Глеб Антонович Мальгин,
Денис Геннадьевич Брешенков,
Дийяра Алиевна Чакал,
Анна Борисовна Степаненко,
Андрей Павлович Генс,
Юрий Владимирович Белов

Журнал: Кардиология и сердечно-сосудистая хирургия. 2026;19(2):5-13.

DOI: 10.17116/kardio2026190215

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Abstract

OBJECTIVE

To present the early and long-term outcomes of wound healing following retroperitoneal thoracophrenolumbotomy for open repair of thoracoabdominal aortic aneurysms and mega-aortic syndrome.

MATERIAL AND METHODS

Between 2010 and September 2025, 358 patients underwent open surgical repair for thoracoabdominal aortic disease and mega-aortic syndrome. In-hospital outcomes were analyzed retrospectively. Long-term wound healing was evaluated at follow-up visits and through telephone interviews. Postoperative pain was assessed using the visual analogue scale (VAS). Primary endpoints were incidence of in-hospital infectious wound complications and late noninfectious incisional complications. Secondary endpoints were incidence of acute and chronic postoperative pain syndrome.

RESULTS

A total of 320 consecutive patients met the inclusion criteria. Long-term wound healing outcomes were available in 231 (72.2%) patients. Infectious wound complications occurred in 46 (14.4%) patients, including 15 (4.7%) cases of deep infection involving musculoskeletal structures. Late noninfectious thoracophrenolumbotomy-related complications were documented in 59 (25.5%) patients. These events included left flank ventral hernia and muscle relaxation (“flank bulge”) in 36 (15.6%) cases, costal arch mobility or diastasis with pain in 27 (11.7%) cases, pulmonary hernia in 1 (0.4%) case, diaphragmatic hernia in 1 (0.4%) case and titanium rib plate dislocation with pain in 1 (0.4%) case. Seven patients had combined complications. Uncomplicated wound healing was observed in 172 (74.5%) patients. Severe in-hospital postoperative pain was reported by 80 (25%) patients. In long-term period, chronic pain syndrome occurred in 54 (23.4%) cases. Of these, 25 (10.8%) patients rated pain ≥4 points (moderate pain), 5 (2.2%) patients — ≥6 points (severe pain). Most often, pain was localized in the chest and costal arch (chronic postthoracotomy pain syndrome) and could have neuropathic component (paresthesia and dysesthesia).

CONCLUSION

Extensive nature of thoracophrenolumbotomy, involving multiple anatomical regions, predisposes to various early and late incision-related complications. Technical refinement of approach and improved patient education can improve postoperative outcomes and reduce complication rates.

Keywords

  • thoracophrenolumbotomy
  • surgical approach
  • thoracoabdominal aneurysm
  • mega-aortic syndrome
  • aortic dissection
  • wound complications
  • hernia
  • pain syndrome
  • cryoablation of intercostal nerves

Дата поступления: 14.01.2026

Дата принятия в печать: 29.01.2026

Дата публикации: 08.04.2026

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