[Surgery of the adrenal glands. Advantages and disadvantages of an anterior versus a posterior approach].
From Jan. 1984 until Oct. 1990 87 adrenalectomies in 75 patients were performed. In 29 patients the transabdominal anterior approach via a transverse upper abdominal laparotomy was carried out for unilateral left (18 pat.) or right adrenalectomy (11 pat.). 46 patients underwent 58 adrenalectomies using the posterior approach as described by Mayor. Using this approach with the patient in prone position, the 11th rib is resected, the pleural reflection identified, the Gerota's fascia incised and the suprarenal space exposed. When the anterior approach was used, blood transfusions were required in 34%. On the other hand, with the dorsal approach, a transfusion was necessary in only 4% of the patients. In 3 of 18 anterior left adrenalectomies a splenectomy was required (17%). The previous was not necessary in any patient having undergone a posterior adrenalectomy. Using the anterior approach postoperative hemorrhage occurred in 7%. No cases of bleeding were observed after posterior adrenalectomy. The average hospital stay was 14.6 days in the transabdominal and 8.5 days in the posterior group. The dorsal approach can only be used in cases in which the tumour is less than 5 cm. For larger of malignant tumours the transabdominal approach is mandatory. In conclusion the posterior adrenalectomy is superior to the anterior and should therefore be employed in appropriate cases.
Steckmeier
B
B
Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München.
Waldner
H
H
Schmölder
A
A
Schweiberer
L
L
D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000311:Adrenal Glands / Q000098:blood supply / Q000473:pathology; D000315:Adrenalectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology
Die Chirurgie der Nebennieren. Vor-und Nachteile des anterioren und dorsalen Zugangs.