Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy

Background: This study reviewed the results of initial experiences of open posterior adrenalectomy and transperitoneal laparoscopic adrenalectomy in 46 patients. Methods: Twenty-three adrenalectomies were performed using the open posterior approach. Detailed records of the patients' operative and postoperative progress were compared with those of the first 36 laparoscopic adrenalectomies undertaken for a similar range of conditions. Results: Conversion to laparotomy was necessary in one of 23 open posterior adrenalectomies and five of 36 laparoscopic adrenalectomies. The mean operating time for laparoscopic unilateral adrenalectomy was nearly double that for open surgery (158 versus 85 min). Postoperative complications occurred more frequently in the open adrenalectomy series (12 of 23 versus two of 36) but one late unexplained death followed bilateral laparoscopic adrenalectomy. A mean reduction in hospital stay of 5 days was recorded after laparoscopic adrenalectomy (range 2-5 days for laparoscopic versus 6-11 days for open operation). Conclusion: Transperitoneal laparoscopic adrenalectomy was attended by a lower morbidity rate than open adrenalectomy and patients were discharged from hospital more quickly.