Initial experience of abdominal aortic aneurysm repairs in Borneo.

Background: Abdominal aortic aneurysms (AAA) repairs are routine operations with low mortality in the developed world. There are few studies on the operative management of AAA in the Asian population.This study reports the initial results from a unit with no previous experience in this surgery by a single surgeon on completion of training.

Methods: All patients with AAA repair from a prospective database between 1996 and 1999 in the south-east Asian state of Sarawak in Borneo Island were analyzed. Three groups were identified on presentation according to clinical urgency of surgery. Elective surgery was offered to all good risk patients with AAA of >or= 5 cm. All symptomatic patients were offered surgery unless contraindicated medically.

Results: AAA repairs were performed in 69 patients: 32 (46%)had elective repairs of asymptomatic AAA; 20 (29%) had urgent surgery for symptomatic non-ruptured AAA; and 17 (25%)had surgery for ruptured AAA. The mortality rate for elective surgery was 6%; the two deaths occurred early in the series with the subsequent 25 repairs recorded no further mortality. The mortality rates for the urgent, symptomatic non-ruptured AAA repair and ruptured AAA repair were 20% and 35%, respectively. Cardiac and respiratory complications were the main morbidities.Sixty-three patients seen during this period had no surgery; three presented and died of ruptured AAA, 34 had AAA of or= 5 cm diameter had either no consent for surgery or serious medical contraindications.

Conclusion: This study showed that AAA can be repaired safely by highly motivated and adequately trained surgeons in a hospital with little previous experience.