Laparoscopic adrenalectomy by the lateral transperitoneal approach in patients with a history of previous abdominal surgery.

Abstract

IntroductionEven the half of patients undergoing laparoscopic adrenalectomy has history of previous abdominal surgeries. However, it is still uncertain if this fact has an impact on the operation itself as well as the postoperative course.AimTo analyze the effects of previous abdominal surgery on surgical outcomes in adrenal tumor patients subjected to laparoscopic adrenalectomy.Material and methodsThis study included 268 patients with adrenal gland tumors operated on by means of laparoscopic lateral transperitoneal adrenalectomy: 1) previously subjected to at least one abdominal surgery (group A, n = 101), or 2) with no history of previous abdominal operations (group B, n = 167).ResultsGroups A and B did not differ in terms of tumor size (p = 0.132), mean operation time (p = 0.456), mean intraoperative blood loss (p = 0.754), or perioperative complication rate (p = 0.833). Dissection of intraperitoneal adhesions was considered difficult in 32 patients from group A (31.6%) and 8 subjects from group B (4.7%, p < 0.001). Conversion was required in three subjects from group A (2.9%) and 3 patients from group B (1.8%, p = 0.529).ConclusionsPrevious abdominal surgery does not constitute a contraindication to laparoscopic transperitoneal adrenalectomy.

The usefulness of laparoscopic adrenalectomy in the treatment of adrenal neoplasms — a single-centre experience

“…The number of non-severe complications of laparoscopic adrenalectomy, reaching 10%, is acceptable. Conversions to the open method are done in 5% of all cases [13][14][15]. Similar results were found in the presented study as well as in patients with malignancies and in patients with benign tumours not hormonally active.…”

Laparoscopic transperitoneal adrenalectomy in morbidly obese patients is not associated with worse short‐term outcomes

“…28 Especially as laparoscopic approach is no worse than retroperitoneal, and can also be carried out in patients after previous abdominal surgeries. 29,30 Hence, in all of these cases, we suspect a malignant process to some extent. In addition, all our patients with bilateral adrenal pathology undergo a two-staged procedure, so changing position is not an issue.…”

“…As most incidentalomas >4 cm are removed for oncological reasons, careful inspection of the abdominal cavity is of great importance in these cases . Especially as laparoscopic approach is no worse than retroperitoneal, and can also be carried out in patients after previous abdominal surgeries . Hence, in all of these cases, we suspect a malignant process to some extent.…”

Our Experiences With Laparoscopic Transperitoneal Adrenalectomy

“…Laparoscopic adrenalectomy has become a gold standard in recent times due to a lesser need for analgesics and less bleeding during and after surgery, low complication rates, and short hospital stays. [2] Its indications have been further expanded in recent years, saying that large adrenal masses and adrenal metastases can also be removed laparoscopically. [3,4] However, care needs to be taken in the selection of cases for primary adrenal malignancies.…”