POSTERIOR APPROACH FOR ADRENAL SURGERY - EXPERIENCES WITH 59 PATIENTS

Background: The laparoscopic approach has become popular for adrenal s urgery. Aim: When starting with laparoscopic adrenalectomies we studie d our experiences of posterior open approach for different adrenal dis orders to obtain reference data. Material and Methods: Between 1983 an d 1993 95 adrenalectomies were performed, of which 59 were via the pos terior route. There were 51 unilateral (7 phaeochromocytomas, 6 Cushin g's syndromes, 33 Conn's syndromes, 1 sex steroid secreting tumour and 4 incidentalomas) and 8 (Cushing's disease) bilateral adrenalectomies . Results: Of the 4 incidentalomas one was a benign adenoma, one was c yst, one was cortical carcinoma, and one was a metastasis from breast cancer. Operative blood loss was median 300 ml, being higher in the bi lateral than in the unilateral adrenalectomies (median 500 (range 300- 1 250) ml vs. 300 (30-4 500 ml) (P = 0.01). Complications occurred in overall 11 patients (19 %) (8 wound infections, 3 postoperative bleedi ng, 2 pneumonias, 1 urinary infection). Complications were more freque nt in Cushing's patients than in the others (6/14 (43 %) vs. 5/45 (11 %); P = 0.015). Postoperative hospital stay was median 8 (range 5-21) days. The patients started liquids orally and were mobilised on the fi rst post operative day, except for the 3 re-operated patients. Thrombo embolic complications did not occur. Narcotics were used postoperative ly for median 2 (range 0-7) days. Conclusions: With the posterior appr oach mortality and complications related to the pancreas, spleen, colo n and duodenum were avoided. Other complications were rare except for the patients with Cushing's disease or syndrome.