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The extraperitoneal approach is not usually used for reconstruction of the abdominal aorta; however, herein we have made an attempt to influence vascular surgeons to modify this practice. The results in 200 patients approached extraperitoneally have been compared with those of 70 patients explored by the traditional transperitoneal route. The expeditious technique of extraperitoneal exploration described results in significantly less postoperative morbidity due to the pulmonary complications of atelectasis and pneumonia. Intestinal ileus is uniformly brief, and rarely requires nasogastric suction. Patients explored extraperitoneally have demonstrably less pain and were discharged from the hospital sooner. Furthermore, prosthetic graft patency and mortality were comparable in both groups. Thus, the retroperitoneal approach should be the preferred method of aortoiliac reconstruction since the postoperative convalescence period is smoother and shorter.

Regional trauma system implementation is proceeding in a number of areas of the United States in response to a demonstrated need for improved trauma care to prevent unnecessary death. The critical questions underlying the design of such systems and the current state of knowledge and opinion regarding each of them have been defined and these provide a framework for system planning. Additional data are badly needed in several areas to provide a more rational basis for system configuration. It is hoped that systems currently being implemented will include appropriate data elements in their trauma registries to answer the remaining questions in succeeding years.