Surgery of the adrenal glands in Cushing's syndrome

Our surgical experience for the Cushing syndrome, reviewed in 23 patients. The accuracy of localizing adrenal lesions increased recently. The present study shows that, adrenal surgery, after accurate diagnosis and localisation, can be performed with low morbidity and mortality.     

Surgery of the adrenal glands. Advantages and disadvantages of an anterior versus a posterior approach

From Jan. 1984 until Oct. 1990 87 adrenalectomies in 75 patients were performed. In 29 patients the transabdominal anterior approach via a transverse upper abdominal laparotomy was carried out for unilateral left (18 pat.) or right adrenalectomy (11 pat.). 46 patients underwent 58 adrenalectomies using the posterior approach as described by Mayor. Using this approach with the patient in prone position, the 11th rib is resected, the pleural reflection identified, the Gerota's fascia incised and the suprarenal space exposed. When the anterior approach was used, blood transfusions were required in 34%. On the other hand, with the dorsal approach, a transfusion was necessary in only 4% of the patients. In 3 of 18 anterior left adrenalectomies a splenectomy was required (17%). The previous was not necessary in any patient having undergone a posterior adrenalectomy. Using the anterior approach postoperative hemorrhage occurred in 7%. No cases of bleeding were observed after posterior adrenalectomy. The average hospital stay was 14.6 days in the transabdominal and 8.5 days in the posterior group. The dorsal approach can only be used in cases in which the tumour is less than 5 cm. For larger of malignant tumours the transabdominal approach is mandatory. In conclusion the posterior adrenalectomy is superior to the anterior and should therefore be employed in appropriate cases.