Retroperitoneoscopic Adrenalectomy in Obese Patients: Is It Suitable?

Zonča, P; Bužga, Marek; Ihnát, Peter; Martínek, L

doi:10.1007/s11695-014-1475-8

Cited by 30 publications

(33 citation statements)

References 29 publications

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“…The retroperitoneal approach seems to be less effective in patients with increased BMI due to the relatively thick lumbar subcutaneous layer, which leads to less effective port placement and, thus, hampered and unsafe retroperitoneal manipulation. Although Zonca et al claimed that RP is safe and effective even for patients with BMI values over 40 [22], most publications recommend TP for obese (BMI: > 30) patients [5].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]

et al. 2020

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Background The superiority of laparoscopic transperitoneal (TP) versus retroperitoneal (RP) adrenalectomy is an ongoing debate. Methods Data from 163 patients (TP: n = 135; RP: n = 28) undergoing minimally invasive adrenalectomy were analyzed. Both operative [intraoperative blood loss, previous abdominal surgery, conversion rate, operative time and tumor size] and perioperative [BMI (body mass index), ASA (American Society of Anesthesiologists) score, time of hospitalization, time of oral intake, histology and postoperative complications] parameters were compared. Both the learning curve (LC) and tumor size were analyzed. Results We found significant differences in the mean operative time (p = 0.019) and rate of previous abdominal surgery (p = 0.038) in favor of TP. Significantly larger tumors were removed with TP (p = 0.018). Conversion rates showed no significant difference (p = 0.257). Also, no significant differences were noted for time of hospitalization, intraoperative blood loss and postoperative complications. In terms of the LC, we saw significant differences in previous abdominal surgery (p = 0.015), conversion rate (p = 0.011) and operative time (p = 0.023) in favor of TP. Large (LT) and extra-large tumors (ELT) were involved in 47 lesions (LT: 40 vs. ELT: 7), with a mean tumor size of 71.85 and 141.57 mm, respectively. Mean intraoperative blood loss was 64.47 ml vs. 71.85 ml, time of hospitalization was 5.10 vs. 4.57 days and mean operative time was 76.52 vs. 79.28 min for LT and ELT, respectively. Conclusion A shorter operative time and lower conversion rate in favor of TP were noted during the learning curve. TP proved to be more effective in the removal of large-, extra-large and malignant lesions. The RP approach was feasible for smaller, benign lesions, with a more prolonged learning curve.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]

et al. 2020

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“…24,26 For instance, Zon ca et al suggested that retroperitoneoscopic access can also be used safely in morbidly obese patients, and indeed might be associated with more favorable postoperative course, shorter hospital stay, better cosmetic outcome and quicker recovery. 27 In his opinion, it might also be more convenient in cases of bilateral adrenal tumors. In our center, laparoscopic transperitoneal lateral approach is the preferred access to adrenal pathology.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transperitoneal adrenalectomy in morbidly obese patients is not associated with worse short‐term outcomes

et al. 2016

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Objectives: To evaluate the impact of obesity and morbid obesity on short-term outcomes after laparoscopic adrenalectomy. Methods: The study included 520 consecutive patients undergoing laparoscopic adrenalectomy for adrenal tumor. The entire study group was divided depending on the body mass index: group 1 (normal weight), <25 kg/m . Additionally, group 4 (morbidly obese) was distinguished. Study end-points were: operative time, intraoperative blood loss, total length of hospital stay, morbidity rate and 30-day readmission rate. Results: The mean operative times were 88.8, 94.7, 93.5, and 99.9 min in groups 1, 2, 3 and 4, respectively (P = 0.1444). Complications were comparable between groups (12.8% vs 8.8% vs 8.2% vs 11.5%, P = 0.5295). The mean intraoperative blood loss was 66.8 versus 78.3 versus 60.7 versus 92.4, P = 0.1399. There were no differences in conversion rate between groups. Conclusions: Obesity has no influence on short-term outcomes of laparoscopic transperitoneal adrenalectomy. This procedure is feasible regardless of the body mass index. Therefore, it can be offered to all patient groups including those morbidly obese individuals in whose case preoperative weight loss seems unnecessary.

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“…Constipation affects 2–27% of the western population, but the relationship between obesity and constipation is still unclear [ 20 ]. Some authors reported no association between increasing BMI and constipation prevalence [ 21 – 23 ], while other authors found a higher rate of constipation in obese individuals [ 24 , 25 ]. Our study data confirmed that constipation presents a common problem in obese individuals (37.1% of patients reported symptoms of constipation and reached WCS ≥ 5 before surgery).…”

Section: Discussionmentioning

confidence: 99%

Changes in bowel habits after laparoscopic sleeve gastrectomy.

Ostruszka

Vávra

Tulinský

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction Bariatric surgery has a significant impact on dietary intake, weight loss, patient’s metabolism and also on defaecation stereotypes. Aim To investigate changes in bowel habits of morbidly obese patients after laparoscopic sleeve gastrectomy (LSG). Material and methods This was a prospective clinical cohort study conducted to assess changes in bowel habits after LSG in a single institution. Results In total, 124 patients were enrolled in the study (age 47.1 ±11.2 years, body mass index (BMI) 44.3 ±6.8 kg/m 2 ). The mean weight loss 6 months after LSG was 29.1 ±11.1 kg; percentage excess weight loss was 56.2 ±20.4%. Before surgery, 35.5% of patients had constipation and 6.5% of patients had faecal incontinence (FI). No correlation was found between rising level of BMI and constipation or incontinence prevalence/severity. Data analysis has not confirmed increased prevalence/severity of postoperative constipation or incontinence 6 months after LSG. Out of the group of patients with preoperative constipation, clinically relevant improvement was noted in 45.5% of patients after the surgery. Among patients without constipation before surgery, impairment was noted in 21.2% of patients. Out of the group of patients with preoperative incontinence, improvement was found in 37.5% of patients; none of these patients reported clinically relevant impairment of incontinence symptoms. Conclusions The present study has not revealed increased prevalence/severity of postoperative constipation or anal incontinence 6 months after LSG. Our findings suggest that weight loss in patients after LSG might be associated with an improvement of constipation symptoms of individual patients.

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Retroperitoneoscopic Adrenalectomy in Obese Patients: Is It Suitable?

Cited by 30 publications

References 29 publications

Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]

Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]

Laparoscopic transperitoneal adrenalectomy in morbidly obese patients is not associated with worse short‐term outcomes

Changes in bowel habits after laparoscopic sleeve gastrectomy.

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