Laparoscopic vs open adrenalectomy for benign adrenal neoplasm - A comparative study

Background: The aim of this study was to compare the outcome of laparoscopi c adrenalectomy (LA) performed for benign adrenal neoplasm to the open proc edure in a similar group of patients. Methods: All consecutive patients who underwent LA between June 1996 and Fe bruary 1999 were evaluated. Data analysis included patient's age and gender , indication for surgery, histological diagnosis, size of specimen, comorbi d conditions, length of stay and ileus, postoperative narcotic consumption, and time to return to normal activity. The results were compared retrospec tively to a well-matched group of patients who underwent an open adrenalect omy (OA). Results: Twenty-eight LA were performed in 24 patients for the following di sorders: adrenocortical adenoma, 16 (four Cushing's syndrome, 12 Conn's syn drome); pheochromocytoma, 10; and nonfunctioning tumor, two. These cases we re compared with a well-matched group of 28 patients who underwent OA in th e same department. There were two conversions to open surgery (7%) in the l aparoscopic group and no deaths in either group. Of all the evaluated param eters, the following statistically significant differences between the two groups were noted: The mean operative time was longer in the LA group (188 vs 139 min, p<0.001.); however, this became insignificant in the last 10 ca ses of LA, when the mean length of surgery was reduced to 130 min. The over all morbidity was lower in the LA group (16% vs 39%, p=0.05), as was the me an time to tolerate a regular diet (2 vs 3.9 days), mean meperidine consump tion (mg) (109 vs 209), mean length of stay (4 vs 7.5 days), and mean time to return to normal activity (2.2 vs 5.2 weeks), (p<0.001 for all). Conclusion: LA for benign adrenal disorders is a safe procedure that is ass ociated with significantly lower morbidity, shorter ileus and hospitalizati on, reduced postoperative pain, and a faster return to normal activity than the open procedure.