Laparoscopic left and right adrenalectomy from an anterior approach - is there any difference? Outcomes in 176 consecutive patients.

IntroductionThe primary treatment of Conn’s syndrome (CS) is laparoscopic adrenalectomy and aims to normalize arterial blood pressure and biochemical parameters.AimTo analyse short- and long-term results of laparoscopic adrenalectomy for Conn’s syndrome (CS).Material and methodsThe analysis included 44 consecutive patients, who underwent laparoscopic adrenalectomy between 2004 and 2015 for CS. We analysed short- and long-terms results of operations. All patients were followed up 6 and 24 months after surgery to determine changes in the biochemical parameters, and clinical regression of arterial hypertension. We also evaluated the aldosteronoma resolution score (ARS) in predicting the resolution of hypertension.ResultsNo conversions were needed. Complications occurred in 5 (11.4%) patients. Preoperative hypokalaemia and hypernatraemia were present in 83.4% and 15.8% of patients, respectively. After surgery, both hypokalaemia and hypernatraemia resolved in all patients. At the follow-up 6 months after the surgery, only 11.3% of patients had complete remission (CR) of hypertension. In 43.2% of cases we observed partial remission (PR). After 24 months CR was found in 13.6% of patients, 45.5% patients fulfilled criteria for PR, and 29.5% of patients changed the group of remission comparison to the first follow-up visit. Only 50% of patients with an ARS of 4 or 5 points achieved CR 6 months after surgery.ConclusionsLaparoscopic adrenalectomy is a safe method of treatment for CS. Although it effectively eliminates electrolyte imbalance, it does not allow for the CR of hypertension in the majority of patients, especially in the elderly group. We did not find ARS to be an effective tool in predicting postoperative resolution of hypertension.

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 90%

Short- and long-term results of laparoscopic adrenalectomy for Conn's syndrome.

Wierdak¹,

Sokołowski²,

Natkaniec³

et al. 2018

“…Although PRA and LTA seem to have similar effectiveness and safety [ 16 – 18 ], LTA is preferable in patients with larger tumors (> 8 cm), obesity, and stage 3 or 4 renal insufficiency [ 10 ]. Moreover, most general surgeons prefer LTA over PRA because they are more familiar with LTA [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Lateral laparoscopic adrenalectomy in patients with previous abdominal surgery - single-center experience.

Toutounchi

Pogorzelski

Legocka

et al. 2018

IntroductionLateral transabdominal adrenalectomy (LTA) is the most common minimally invasive technique used to treat patients with adrenal tumors.AimTo analyze intra-operative and post-operative complications and reasons for conversion to open surgery in patients who underwent LTA and had previous abdominal surgery.Material and methodsFive hundred and nineteen patients underwent LTA in our center between 2005 and 2016. We identified a study group of 150 patients, with previous abdominal surgery. We analyzed the frequency of intra-operative and post-operative complications and the reasons for conversion from laparoscopic to open adrenalectomy.ResultsThe patients’ mean age was 58; they underwent LTA due to hormonally active tumors (n = 79, 53%) and non-functioning adrenal tumors (n = 71, 47%). The size of adrenal lesions ranged from 20 mm to 90 mm. Seventy-eight (52%) adrenal lesions were found in the right adrenal gland, and 72 (48%) lesions in the left adrenal gland. The mean operating time was 130 min. The mean stay in hospital was five days. The intra-operative complications included blood pressure fluctuations (n = 32), abnormal vascular supply of the adrenal glands causing difficulties with dissections (n = 3), and respiratory problems (n = 1). Two (1.3%) patients had post-operative bleeding at the site of removed adrenal glands; 1 patient had an exacerbation of asthma postoperatively. Of the 150 patients analyzed, 3 (2%) required conversion to open adrenalectomy. The conversions were not caused by abdominal adhesions.ConclusionsLateral transabdominal adrenalectomy is feasible and safe in patients with previous abdominal surgery. In our study, conversion from laparoscopic to open adrenalectomy was not caused by abdominal adhesions.

“…According to others, adrenal-sparing surgery may be performed after hormonal hyperactivity is ruled out, when the likelihood of cancer is considered to be low, or when the cyst is found to be large. The surgical procedure involves the resection or marsupialization of the cystic wall [ 2 , 11 – 14 ]. The authors of this study are among the advocates of the latter strategy.…”

Section: Discussionmentioning

confidence: 99%

Adrenal cysts - optimal laparoscopic treatment.

Pogorzelski

Toutounchi

Krajewska

et al. 2018

IntroductionAdrenal cysts develop in up to about 0.2% of the overall population. They may account for up to 11% of all pathologies of adrenal glands.AimIs laparoscopic resection of adrenal cysts a method for the treatment of these pathologies?Material and methodsIn the years 2010–2017, a total of 27 patients underwent surgery due to adrenal cysts; those included 18 (66.7%) women and 9 (33.3%) men aged 29 to 84 years (mean age: 42.7). Cyst diameter ranged from 55 to 130 mm. After exclusion of hormonal hyperactivity, parasitic cysts, or, to the best possible extent, cancer lesions, patients were qualified for adrenal-sparing laparoscopic surgery.ResultsAll patients were subjected to laparoscopic surgery. Cystic wall resection was performed in 15 (55.6%) patients while adrenalectomy was performed in the remaining 12 (44.4%) patients. The decision regarding the extent of the surgery was made intraoperatively. Histopathological assessment revealed pathological adrenal lesions in as few as 3 (11.1%) patients, with the rest of the study population, i.e. 24 (88.9%), presenting with normal adrenal tissue.ConclusionsLaparoscopic resection of adrenal cysts appears to be recommendable as a method for the treatment of these pathologies. It is simpler than adrenalectomy and associated with low risk of any pathological lesion remaining within the adrenal gland following careful intraoperative assessment by an experienced surgeon.