Introduction Patients undergoing unilateral adrenalectomy for primary aldosteronism (PA) may have a solitary adenoma, unilateral hyperplasia, or multiple adenomas on final pathology. This study investigated whether the underlying pathological diagnosis was associated with differences in clinical presentation and postoperative outcomes. Methods A retrospective cohort study of patients undergoing unilateral adrenalectomy for PA from 2004 to 2015 at our institution was performed. Baseline clinical and laboratory parameters, as well as postoperative biochemical and hypertension cure rates, were compared across the three aforementioned pathological groups. Results Of 206 patients who met criteria for inclusion, 152 (73.8%) had a single adenoma, 33 (16%) had unilateral hyperplasia, and 21 (10.2%) had multiple unilateral adenomas. Patients with unilateral hyperplasia were more likely to be male (81.2% vs 57.9%, P = .03), undergo left-sided adrenalectomy (78.8% vs 47.4%, P \ .01), and had a lower median adrenal venous sampling lateralization index (9.8 vs 19.8, P = .04) compared to those with solitary, but not multiple unilateral adenomas. No differences were seen in age, duration of hypertension, preoperative plasma aldosterone levels, plasma renin activities, 24-h urinary aldosterone excretion, serum potassium concentrations, and the number of preoperative antihypertensive medications across all three pathological groups. All patients achieved biochemical cure following adrenalectomy, and no significant differences in the rates of hypertension cure or improvement were observed in comparisons across pathological subtype. Conclusions Clinical presentation and postoperative outcomes are similar regardless of underlying pathology in patients with PA. Because one in four patients may harbor unilateral hyperplasia or multiple adenomas, total unilateral adrenalectomy should be performed as the operation of choice over adrenal-sparing approaches.

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Background: Severe obesity leads to a higher incidence of ventral hernias, thus complicating up to 8% of bariatric procedures. The optimal management of these hernias continues to be a controversial topic. We present our novel approach of utilizing an omental plug for concomitant ventral hernia management during metabolic surgery. Methods: To prevent early bowel incarceration and obstruction during bariatric surgery, we sutured the omentum circumferentially to the edges of the hernia defect and to the hernia sac itself with absorbable suture. Results: Four patients were managed with this novel omental plug technique. All patients were female. The mean age was 53 years (range 39 to 68 y), the mean body-mass index was 54.75 kg/m2 (range 49 to 59 kg/m2), and the mean follow-up was 4.6 months (range 1.5 to 6.5 mo). There were no hernia-related complications through the follow-up period. Conclusion: The omental plug technique is a feasible, inexpensive, and safe alternative for ventral hernias with the potential prevention of bowel incarceration during bariatric surgery. This approach allows deferring the definitive hernia repair for a later stage.