In this non-randomised retrospective study we have compared 79 cases with transperitoneal approach and 90 cases with extended postero-lateral extraperitoneal approach for elective reconstruction of the infrarenal aorta. In the extraperitoneal group more patients were diabetic (7.8% vs 1.3%, p < 0.05) or had a serum creatinine of more than 1.5 mg % (10.1% vs 2.5%, p < 0.05). The study shows that in spite of a higher proportion of risk factors, a longer preparation (61' vs 44', p < 0.001), dissection (55' vs 46', p < 0.05) and total procedure time (193' vs 173', p < 0.05), the need for more blood transfusion (2.8 U vs 2.3 U, p < 0.05) and colloid perfusion (2.1 L vs 1.8 L, p < 0.05) in the extraperitoneal group, the incidence of complications is not higher compared to the transperitoneal group (29% vs 24%, NS). On the contrary, problems of intestinal transit were found exclusively in the transperitoneal group (7.6%, p < 0.01). Therefore it seems that, as far as the peri- and postoperative period is concerned the extraperitoneal approach might be the technique of choice for the simple elective infrarenal aorta reconstructions.