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World Journal of Surgery

, Volume 32, Issue 5, pp 897–903 | Cite as

Laparoscopic Adrenalectomy After Prior Abdominal Surgery

  • Lilah MorrisEmail author
  • Philip Ituarte
  • Rasa Zarnegar
  • Quan-Yang Duh
  • Leaque Ahmed
  • James Lee
  • William Inabnet III
  • Goswin Meyer-Rochow
  • Stan Sidhu
  • Mark Sywak
  • Michael Yeh
Article

Abstract

Background

Compared with the open procedure, laparoscopic adrenalectomy (LA) is associated with decreased operative time, perioperative complications, and hospital stay. Some regard prior abdominal surgery as a contraindication to LA or suggest a retroperitoneoscopic approach. We studied the effect of prior abdominal surgery on the feasibility and safety of transabdominal LA.

Methods

We retrospectively analyzed 246 consecutive LAs performed at four academic centers from 2002 to 2006. Cases were grouped according to prior abdominal surgery (PAS) (n = 92, 37%) or no prior surgery (NPS) (n = 154, 63%). Statistical power was greater than 0.90 to detect the following differences in endpoints: conversion 2%, operating time 22%, and complications 2%.

Results

Mean tumor size was 3.3 cm, 8.1% of tumors were larger than 7 cm, and 20% were pheochromocytomas. Prior operations were upper abdominal (37%), lower abdominal (48%), or laparoscopic (15%). There were nine conversions (3.7%), one in the PAS group and eight in the NPS group (p = 0.14), with conversions related to large tumor size and pheochromocytoma (both p < 0.01). Operating time was 158 ± 59 min across groups. The subgroup with prior upper abdominal surgery had nonsignificantly longer operating times compared with the NPS group (183 vs. 165 min, p = 0.16). Operative blood loss was 67 ± 84 ml and the perioperative complication rate was 12.2%, with no differences between groups.

Conclusion

Prior abdominal surgery does not impede transabdominal LA. More than one-third of patients requiring adrenalectomy will have had prior abdominal surgery, and these patients should not be denied the benefits of a laparoscopic procedure.

Keywords

Laparoscopic Cholecystectomy Estimate Blood Loss Laparoscopic Adrenalectomy Technical Complication Prior Abdominal Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors acknowledge A.W. James and S.G. Miranda for their assistance in data collection.

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Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Lilah Morris
    • 1
    Email author
  • Philip Ituarte
    • 2
  • Rasa Zarnegar
    • 3
  • Quan-Yang Duh
    • 3
  • Leaque Ahmed
    • 4
  • James Lee
    • 4
  • William Inabnet III
    • 4
  • Goswin Meyer-Rochow
    • 5
  • Stan Sidhu
    • 5
  • Mark Sywak
    • 5
  • Michael Yeh
    • 2
  1. 1.Department of SurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Endocrine Surgical UnitDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Endocrine Surgery SectionColumbia University Medical CenterNew YorkUSA
  5. 5.Endocrine Surgical UnitUniversity of SydneySydneyAustralia

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