A few notes of caution may be raised to the conclusions of this article. The evidence of the literature as referenced by Luebke et al although variable suggests that if concomitant operations are judiciously applied, graft infection rates remain low enough that small but clinically significant differences in rates of graft infection may be hard to demonstrate given the relatively small number of patients in the reported case series of concomitant operations. Removal of the noninflamed gall bladder, if indicated, after an aortic graft has been covered by careful closure of the retroperitoneum is generally considered safe. All of the patients in the authors' case series who underwent cholecystectomy had symptomatic biliary tract disease. However, I question both the necessity and the safety of placing a synthetic aortic graft in the presence of acute intra-abdominal infection and inflammation (eg, acute diverticulitis or acute appendicitis). The single case of a concomitant subtotal colectomy for colon infarction must have represented a special and severe problem and cannot be generally recommended.
Bredenberg CE. Simultaneous Gastrointestinal Surgery in Patients With Elective Abdominal Aortic Reconstruction—Invited Critique. Arch Surg. 2002;137(2):148. doi:10.1001/archsurg.137.2.148