Laparoscopic management of primary hyperaldosteronism: clinical experience with 212 cases.

Abstract

PURPOSE:

Laparoscopy is now widely used to remove benign adrenal tumors. We assessed the value of transperitoneal partial or total adrenalectomy for primary hyperaldosteronism.

MATERIALS AND METHODS:

From September 1994 to October 2001, 212 consecutive patients with a mean age of 48 years who presented with primary hyperaldosteronism and related arterial hypertension underwent transperitoneal laparoscopic adrenalectomy (193) or tumor enucleation (20) performed by a single surgeon, including 1 who underwent bilateral adrenalectomy. In all cases preoperatively high plasma and urine aldosterone was associated with low plasma renin and hypokalemia.

RESULTS:

Mean followup was 44 months. Conversion to open surgery was necessary in 30 patients (14%) due to bleeding or adhesion and a procedure duration of greater than 3 hours. Mean operative time was 102 minutes (range 30 to 260). Six patients (2.8%) required blood transfusion. No deaths occurred. Postoperatively complications were observed in 10% of patients and the most frequent one was electrical myocardial ischemia without infarction. Mean postoperative pain medication was 17 mg. morphine sulfate equivalents (range 0 to 60). Mean and median hospital stay was 3.6 and 2.9 days, respectively (range 2 to 20). Postoperatively blood pressure was normal in 58% of patients without any drug, while treatment was decreased in the remainder. Kalemia was normalized in all cases.

CONCLUSIONS:

Although some complications can occur, mostly at the beginning of the learning curve, laparoscopic transperitoneal adrenalectomy is effective treatment for primary hyperaldosteronism.

• Authors: Paul Meria, Béatrice Fiquet Kempf, Jean François Hermieu, Pierre François Plouin, Jean Marc Duclos
• Journal: The Journal of urology (J Urol) Vol. 169 Issue 1 Pg. 32-5 (Jan 2003) ISSN: 0022-5347 [Print] United States
• PMID: 12478096 (Publication Type: Journal Article)

Topics

• Adrenal Gland Neoplasms (surgery)
• Adrenalectomy (adverse effects, methods)
• Adult
• Aged
• Female
• Follow-Up Studies
• Humans
• Hyperaldosteronism (etiology, surgery)
• Laparoscopy (adverse effects, methods)
• Length of Stay
• Male
• Middle Aged
• Pain, Postoperative
• Postoperative Complications