Posterior approach for adrenal surgery: experiences with 59 patients

The laparoscopic approach has become popular for adrenal surgery.

When starting with laparoscopic adrenalectomies we studied our experiences of posterior open approach for different adrenal disorders to obtain reference data.

Between 1983 and 1993 95 adrenalectomies were performed, of which 59 were via the posterior route. There were 51 unilateral (7 phaeochromocytomas, 6 Cushing's syndromes, 33 Conn's syndromes, 1 sex steroid secreting tumour and 4 incidentalomas) and 8 (Cushing's disease) bilateral adrenalectomies.

Of the 4 incidentalomas one was a benign adenoma, one was cyst, one was cortical carcinoma, and one was a metastasis from breast cancer. Operative blood loss was median 300 ml, being higher in the bilateral than in the unilateral adrenalectomies (median 500 (range 300-1,250) ml vs. 300 (30-4,500 ml) (P = 0.01). Complications occurred in overall 11 patients (19%) (8 wound infections, 3 postoperative bleeding, 2 pneumonias, 1 urinary infection). Complications were more frequent in Cushing's patients than in the others (6/14 (43%) vs. 5/45 (11%); P = 0.015). Postoperative hospital stay was median 8 (range 5-21) days. The patients started liquids orally and were mobilised on the first post operative day, except for the 3 re-operated patients. Thromboembolic complications did not occur. Narcotics were used postoperatively for median 2 (range 0-7) days.

With the posterior approach mortality and complications related to the pancreas, spleen, colon and duodenum were avoided. Other complications were rare except for the patients with Cushing's disease or syndrome.