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

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.