title: One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach.
abstract: BACKGROUND
  The advances in laparoscopic surgical technique and the greater experience of surgical teams have enabled the combination of different surgical techniques in a single procedure. This paper presents a case of a sleeve gastrectomy and a left adrenalectomy by laparoscopy for a morbidly obese patient with Cushing's syndrome.
  
  
  METHODS
  A 52 year-old male patient with a BMI of 53kg/m(2) was diagnosed as having Cushing's syndrome caused by a left adrenal tumor. Sleeve gastrectomy was performed according to the usual technique. The adrenalectomy was performed at the same time by a left supragastric approach. The evolution was favorable, with 52% of excess weight loss observed after six months. Plasma and urinary cortisol at the 3- and 6-month follow-ups were under normal range and the patient required glucocorticoid therapy, confirming the cure of Cushing's syndrome.
  
  
  CONCLUSIONS
  Teams with experience of advanced laparoscopic surgery can successfully combine complex procedures in one surgical period. The approach we used for the adrenalectomy proved itself to be feasible after the sleeve gastrectomy.
  
  
  CONCLUSIONS
  Both procedures can be safely done in experience teams. Sleeve gastrectomy facilitates the direct supragastric approach.
authors.affiliation: Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: gordeju@me.com.
authors.forename: Amador G Ruiz
authors.initials: AG
authors.lastname: de Gordejuela
authors.affiliation: Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Jordi Pujol
authors.initials: JP
authors.lastname: Gebelli
authors.affiliation: Servei d'Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Núria Vilarrasa
authors.initials: NV
authors.lastname: García
authors.affiliation: Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Lluis Secanella
authors.initials: LS
authors.lastname: Medayo
authors.affiliation: Servei d'Endocrinología i Nutrició, Hospital Sant Camil, c/Carç, n°0, 08810 Sant Pere de Ribes, Barcelona, Spain.
authors.forename: Araceli Estepa
authors.initials: AE
authors.lastname: Marín
authors.affiliation: Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Anna Casajoana
authors.initials: AC
authors.lastname: Badía
keywords: Cushing's syndrome; Left adrenalectomy; Morbid obesity; Sleeve gastrectomy