SAFETY OF THE POSTERIOR APPROACH IN ADRENAL SURGERY - EXPERIENCE IN 105 CASES

Background. At the advent of laparoscopic adrenalectomy when it was ti mely to reappreciate the results of time-honored procedures, we review ed the cases of 105 patients who underwent adrenalectomy through the p osterior approach. Methods. Between 1970 and 1992 among 331 patients, 105 underwent adrenalectomy through the posterior approach (0 of 111 p heochromoctyomas, 48 of 64 Conn's disease, 3 7 of 57 Cushing's disease , 2 of 20 virilizing-feminizing tumors, 13 of 61 nonsecreting adrenalo mas, 3 of 12 metastases, 2 of 6 cysts). Adrenalectomy was bilateral in 20 cases. Among 86 tumors, 28 (32.6%) were larger than 5 cm in diamet er, none exceeding 10 cm. Posterior approach, initially performed in t he prone position, was used in the lateral position for the last 40 pa tients with tumors. A hockey-stick incision was made on the twelfth or eleventh rib, which was resected. Results. During operation no patien t died; one minimal caval tear and 13 pleural tears occurred and were sutured, with two pleural drainages; six patients received blood trans fusion. Average operative time was 132 minutes (range, 45 to 290 minut es). After operation one patient died of iatrogenic sepsis, average ti me to ambulation was 1.5 days, and average in-hospital stay was 76 day s (range, 1 to 21), which after the fourth day was mostly justified fo r nonsurgical reasons. From 1990 through 1992, 37 of 38 patients were walking the day after operation and average postoperative stay dropped to 4.5 days (range, 1 to 7 days). Conclusions. Adrenalectomy through the posterior approach is safe and allows early postoperative discharg e.