Laparoscopic adrenalectomy after prior abdominal surgery.
BACKGROUND
Compared with the open procedure, laparoscopic adrenalectomy (LA) is associated with decreased operative time, perioperative complications, and hospital stay. Some regard prior abdominal surgery as a contraindication to LA or suggest a retroperitoneoscopic approach. We studied the effect of prior abdominal surgery on the feasibility and safety of transabdominal LA.


METHODS
We retrospectively analyzed 246 consecutive LAs performed at four academic centers from 2002 to 2006. Cases were grouped according to prior abdominal surgery (PAS) (n=92, 37%) or no prior surgery (NPS) (n=154, 63%). Statistical power was greater than 0.90 to detect the following differences in endpoints: conversion 2%, operating time 22%, and complications 2%.


RESULTS
Mean tumor size was 3.3 cm, 8.1% of tumors were larger than 7 cm, and 20% were pheochromocytomas. Prior operations were upper abdominal (37%), lower abdominal (48%), or laparoscopic (15%). There were nine conversions (3.7%), one in the PAS group and eight in the NPS group (p=0.14), with conversions related to large tumor size and pheochromocytoma (both p<0.01). Operating time was 158+/-59 min across groups. The subgroup with prior upper abdominal surgery had nonsignificantly longer operating times compared with the NPS group (183 vs. 165 min, p=0.16). Operative blood loss was 67+/-84 ml and the perioperative complication rate was 12.2%, with no differences between groups.


CONCLUSIONS
Prior abdominal surgery does not impede transabdominal LA. More than one-third of patients requiring adrenalectomy will have had prior abdominal surgery, and these patients should not be denied the benefits of a laparoscopic procedure.
Morris
Lilah
L
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. lmorris@mednet.ucla.edu
Ituarte
Philip
P
Zarnegar
Rasa
R
Duh
Quan-Yang
QY
Ahmed
Leaque
L
Lee
James
J
Inabnet
William
W
Meyer-Rochow
Goswin
G
Sidhu
Stan
S
Sywak
Mark
M
Yeh
Michael
M
D000005:Abdomen / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome