Open AAA repair

You have an abdominal aortic aneurysm which is large enough to carry a real risk of rupture, which most people do not survive. Your surgeon has looked at the options and after discussion with you, it has been decided that an open operation is the best way of treating this.

It will require a general anaesthetic, and then the surgeon will make an incision in your abdomen, and carefully move the bowels to one side. The aneurysm will be exposed and clamps placed above and below it to prevent bleeding. The aneurysm will then be replaced by a strong fabric tube which is sewn in place with permanent sutures. The clamps will be removed and the operation checked for any bleeding. The muscles and skin of the abdomen will then be repaired and the operation is over.

You should have already had most of the tests in order to make the decision about the best operation. We need a CT scan to see the anatomy of the aneurysm, and an exercise test of your heart and lungs (CPET or similar). There will be some last minute blood tests prior to surgery to make sure you are not anaemic and your kidneys are working well, and also to

The application and removal of the clamps makes the heart work quite hard so even with the best preparation, some patients’ hearts may struggle, particularly if they have previous symptoms of angina or heart attack, or the operation is a long or difficult one. As a result, the main risk is of you having a heart attack, about 4%. Less commonly, the kidneys shut down temporarily due to changes in blood pressure, and a small number of patients (about 1%) need an artifical kidney for a few days. Some operations run into problems with bleeding, and this increases the risk of both kidney and heart complications, as well as the rare need for a second operation.

There are other risks associated with any general anaesthetic and any operation such as chest or wound infection, DVT, difficulty passing water postoperatively, but precautions are routinely taken for these.

The question most patients want answered is the risk of dying associated with the operation. This is about 3-4%, from all possible causes but predominantly heart problems. Your surgeon should discuss these risks with you in the clinci, particularly if your risks are above average, as well as reviewing them just before the operation.

You will be admitted the day before or on the day of surgery. You should not eat or drink from midnight on the day of the operation. You will be seen by the surgical team and sign the consent if not already done, and the anaesthetist will see you to explain about going off to sleep. The ward staff will help you change into a theatre gown, and you will be taken to the anaesthetic room in the theatre department. You will have a needle in the back of your hand which will be used to put you gently to sleep, and then the anaesthetic team will put in other drips and monitoring including a urinary catheter.

After the operation you will wake up in the recovery suite, and remain there for a couple of hours until the team are happy to move you to the High Dependency Unit. You will probably be there about 24-48 hours, then back to the ward.

The drips and catheter will be removed as you begin to eat, drink, and mobilise. You will take sips of fluid from the first day, and begin eating small amounts about day 3. Sometimes people feel a bit queasy and full of gas, the bowels often go to sleep for a few days after the operation so don’t rush eating or drinking.You should be sitting out of bed and walking to the bathroom at about 4 days, and most people are looking to go home at about 7 or 8 days.

You will feel tired. It will take several weeks before you can readily perform the level of activity that you are used to. Take it steadily and don’t overdo it. It may be a while before you get back to your usual sleep pattern.

You may get some abdominal discomfort particularly on lifting or coughing. The Physios will show you how to minimise this, but it improves rapidly. Don’t worry if you find that you aren’t going to the toilet quite as you used to until your bowels get back into their routine.

We will see you in the clinic at 6 weeks to check that you are pretty much back to normal, and the wound is healed well. About a quarter of patients are still on the mend at this stage, particularly patients over 75. With this operation, the chance of late complications is very small, and so we don’t routinely need to review you after this.