[Open versus video-endoscopic approach in the treatment of hypercortisolism by bilateral adrenalectomy].
Progress in the technique of the hypophysectomy and in the imaging procedures reduced drastically the indications of bilateral adrenalectomy (BA) in the treatment of hypercortisolism (HC). Indeed BA is indicated in 10 to 30% after failure of pituitary surgery, when HC is related to ACTH ectopic secretion, and in HC related to autonomous adrenal secretion. The purpose of this work is to demonstrate the validity of the bilateral video endoscopic adrenalectomy (BVA) in regard to open surgery. During the last 20 years, 88 patients were operated on by open adrenalectomy (Group 1), either by transperitoneal approach, or bilateral posterior lombetomy. From 1994, 62 patients (Group 2), were operated by video endoscopy. Two death occurred in group 1. The frequency of the preoperative complications were identical in each group, but postoperative morbidity were lower in the group 2. The fall in the postoperative pain, the simplicity of the follow up, the rapid hospital discharge, the low rate of parietal complications were observed in BVA. We conclude that the postoperative follow up is better after BVA a specialized training and time of adaptation are imposed to the surgeon.
Chapuis
Y
Y
47 avenue du Maréchal Lyautey-75016 Paris.
Dousset
B
B
Pitre
J
J
Picard
A
A
D000315:Adrenalectomy / Q000379:methods*; D000308:Adrenocortical Hyperfunction / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D020535:Video-Assisted Surgery