[The lateral extraperitoneal access in surgery of the adrenal glands]

This study aimed at evaluating lateral extraperitoneal access to adrenals in 233 patients (103 patients with pheochromocytoma, 101 with Conn syndrome, 11 with Cushing syndrome and 18 patients with hormonally inactive tumours) who underwent surgery in our department within 1981-1998. The age of patients ranged from 10 to 84 years. Biochemical tests have been performed and hormones assayed in all of them prior to surgery, and the localization of tumours has been established by means of the abdominal cavity ultrasound examination and CT scans. Two hundred thirty five tumours have been excised. The mean duration of surgery was 91 minutes and the mean time of postoperative hospital stay--5 days. Postoperative complications have been noted in 4.7% of the operated patients but in the group with pheochromocytoma their incidence increased to 8.7%. In 13.7% of cases an accidental opening of pleural cavity was noted. The majority of cases has had drain left in pleural cavity whereas the remaining patients have had pleurae sewn. There were two hospital deaths in the group of pheochromocytoma, i.e. in 0.85% of all patients. These results and complications were analysed in a discussion. It seems that this kind of surgical access to adrenals can be successfully used in most unilateral adrenal pathologies and in cases of extra-adrenal tumours localized along abdominal aorta. Patients with pheochromocytoma are still in increased surgical risk.