Safety of the posterior approach in adrenal surgery: experience in 105 cases

At the advent of laparoscopic adrenalectomy when it was timely to reappreciate the results of time-honored procedures, we reviewed the cases of 105 patients who underwent adrenalectomy through the posterior approach.

Between 1970 and 1992 among 331 patients, 105 underwent adrenalectomy through the posterior approach (0 of 111 pheochromocytomas, 48 of 64 Conn's disease, 37 of 57 Cushing's disease, 2 of 20 virilizing-feminizing tumors, 13 of 61 nonsecreting adrenalomas, 3 of 12 metastases, 2 of 6 cysts). Adrenalectomy was bilateral in 20 cases. Among 86 tumors, 28 (32.6%) were larger than 5 cm in diameter, none exceeding 10 cm. Posterior approach, initially performed in the prone position, was used in the lateral position for the last 40 patients with tumors. A hockey-stick incision was made on the twelfth or eleventh rib, which was resected.

During operation no patient died; one minimal caval tear and 13 pleural tears occurred and were sutured, with two pleural drainages; six patients received blood transfusion. Average operative time was 132 minutes (range, 45 to 290 minutes). After operation one patient died of iatrogenic sepsis, average time to ambulation was 1.5 days, and average in-hospital stay was 7.6 days (range, 1 to 21), which after the fourth day was mostly justified for nonsurgical reasons. From 1990 through 1992, 37 of 38 patients were walking the day after operation and average postoperative stay dropped to 4.5 days (range, 1 to 7 days).

Adrenalectomy through the posterior approach is safe and allows early postoperative discharge.