title: Laparoscopic adrenalectomy after prior abdominal surgery.
abstract: 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.
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. lmorris@mednet.ucla.edu
authors.forename: Lilah
authors.initials: L
authors.lastname: Morris
authors.forename: Philip
authors.initials: P
authors.lastname: Ituarte
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Leaque
authors.initials: L
authors.lastname: Ahmed
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.forename: William
authors.initials: W
authors.lastname: Inabnet
authors.forename: Goswin
authors.initials: G
authors.lastname: Meyer-Rochow
authors.forename: Stan
authors.initials: S
authors.lastname: Sidhu
authors.forename: Mark
authors.initials: M
authors.lastname: Sywak
authors.forename: Michael
authors.initials: M
authors.lastname: Yeh
mesh_terms: 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