Laparoscopic sleeve gastrectomy and left adrenalectomy with supragastric approach

A female patient, 48-year-old, with morbid obesity (body mass index 42.5 kg/m2) complicated by hypertension, T2DM, and severe Obstructive Sleep Apnea Syndrome was candidated to bariatric surgery. During the preoperative work-up, an abdominal ultrasonography and an RMN showed an incidental left adrenal tumor with a diameter of 11 cm. The laboratory evaluation for the functional adrenal tumor was negative. A laparoscopic sleeve gastrectomy and left adrenalectomy with supragastric approach was successfully carried out. The minimally invasive treatment of coexisting abdominal pathologies such as morbid obesity and adrenal incidentalomas seem to be suitable and safe, providing several benefits in terms of surgical and anesthesiologic management and postoperative clinical outcomes. The supragastric approach may represent a valuable option for left adrenalectomy combined with laparoscopic sleeve gastrectomy.