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

Abstract

Objectives: To evaluate the impact of obesity and morbid obesity on short-term outcomes after laparoscopic adrenalectomy. Methods: The study included 520 consecutive patients undergoing laparoscopic adrenalectomy for adrenal tumor. The entire study group was divided depending on the body mass index: group 1 (normal weight), <25 kg/m . Additionally, group 4 (morbidly obese) was distinguished. Study end-points were: operative time, intraoperative blood loss, total length of hospital stay, morbidity rate and 30-day readmission rate. Results: The mean operative times were 88.8, 94.7, 93.5, and 99.9 min in groups 1, 2, 3 and 4, respectively (P = 0.1444). Complications were comparable between groups (12.8% vs 8.8% vs 8.2% vs 11.5%, P = 0.5295). The mean intraoperative blood loss was 66.8 versus 78.3 versus 60.7 versus 92.4, P = 0.1399. There were no differences in conversion rate between groups. Conclusions: Obesity has no influence on short-term outcomes of laparoscopic transperitoneal adrenalectomy. This procedure is feasible regardless of the body mass index. Therefore, it can be offered to all patient groups including those morbidly obese individuals in whose case preoperative weight loss seems unnecessary.

Risk factors for prolonged hospitalization in patients undergoing laparoscopic adrenalectomy.

“…Our department is a tertiary referral university unit. Annually more than 700 laparoscopic procedures are performed – mainly gastric, bariatric, colorectal, pancreatic and hepatobiliary surgeries, with more than 60 cases of adrenalectomy [ 9 , 10 ]. Since 2003 a laparoscopic approach has been the preferred access for adrenalectomy in our unit.…”

Spontaneous adrenal hemorrhage with dehydroepiandrosterone‐sulfate elevation in a patient with suspected adrenal cortical carcinoma

“…The patient in the present case showed spontaneous adrenal hemorrhage, and was therefore categorized as a non‐injury case. Only 20–30 cases of spontaneous adrenal hemorrhage have been reported in Japan …”

“…Only 20-30 cases of spontaneous adrenal hemorrhage have been reported in Japan. 1,5,6 The detailed mechanisms of spontaneous adrenal hemorrhage are still unknown. One possible mechanism involves the blood supply of the adrenal gland.…”

Precision Surgery for Pheochromocytomas and Paragangliomas

“…Laparoscopic adrenalectomy is also feasible in obese patients with PHEO. A study examining transperitoneal laparoscopic adrenalectomy (including 119 patients with PHEO) outcomes in obese patients demonstrated no statistical differences in patients stratified by BMI from normal to morbidly obese in regards to operative time, intra-operative blood loss, the total length of hospital stay, morbidity rate and 30-day readmission rate [112]. A recent retrospective multicenter study comparing hemodynamic instability in 341 patients undergoing either transperitoneal laparoscopic or retroperitoneoscopic adrenalectomy for PHEO revealed statistically significant differences after multi-variate analysis in hemodynamics related to surgical approach; with retroperitoneoscopic adrenalectomy demonstrating decreased intra-operative mean arterial pressure (MAP) ( < 60 mmHg) (odds ratio 6.255, 95 % confidence interval (CI) 1.134-34.235, p = 0.035) when compared to the intra-operative MAP of transperitoneal approach [113].…”