The surgical outcomes in patients with mycotic aortic aneurysm are still poor. In situ reconstruction and extra-anatomical bypass are the 2 main surgical options used in these patients, both of which have postoperative complications: recurrence of infection and aortic stump blowout, respectively. We performed in situ reconstruction in 25 consecutive patients with mycotic abdominal aortic aneurysms together with extended debridement using an irrigation device, omental flap coverage, rifampicin-soaked prosthetic graft, and sufficient antibiotics administration. There were 3 in-hospital mortalities; however, no infection- or procedure-related adverse events were observed in other cases during the mid-term follow-up period.