Open Aneurysm Repair
Why have I been offered this operation ?
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 looke dat the
options and after discussion with you, it has been decided that an
open operation is the best way of treating this.
What does it involve ?
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.
What tests will I need ?
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
What are the risks ?
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
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
What will happen in hospital ?
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
What will happen after I am discharged ?
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
Will I need following up ?
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.