Laparoscopic Transperitoneal Adrenalectomy for Patients with Previous Abdominal Surgery

Background: Adrenal surgery has been radically changed by laparoscopic approach and we wonder whether the increase in the number of adrenalectomies is entirely justified by better understanding of the pathology and a developed diagnosis method. The type of approach (transabdominal/retroperitoneal) remains still a mater of surgeon’s experience.
Method: In past 6 years we performed 152 laparoscopic adrenalectomies by transperitoneal approach, 24 of them having previous significant abdominal surgery (cholecistectomy, gastric surgery, colectomy, bowel obstruction, exploratory laparoscopy, adrenalectomy). The patients had a variety of adrenal pathologies like Cushing’s disease, Cushing’s syndrome, Conn’s syndrome, incidentaloma, pheochromocytoma and even carcinoma.
Results: Three cases were converted to open approach, only one because of the adhesions. Reasons for conversion were also: spleen infarction and a difficulty in mobilizing the tumor. Operating time was not significantly prolonged because of the adhesions (40–360 min, median time 127 min). Postoperative evolution was simple, with no morbidity or mortality and a fast recovery.
Conclusions: Choosing the type of approach is related to surgeon experience, although 79–94% of surgeons prefer the transabdominal lateral approach. We believe that with an experienced surgical team there is no difficulty in performing adrenalectomy by transabdominal approach, with no significantly prolonged operating time, even when the patient had previous abdominal surgery.