Chronological variation of adrenal surgery for the past 28 years--experience with 140 adrenal operations

The author experienced 140 adrenal operations from April, 1958 to March, 1986. Surgery was performed in 54 cases of primary aldosteronism (adenoma - 52, hyperplasia - 2), 46 cases of Cushing's syndrome (carcinoma - 3, adenoma - 22, primary nodular hyperplasia - 1, hyperplasia - 20), 26 cases of pheochromocytoma (tumor - 25, hyperplasia - 1) and 11 other adrenal tumors. During the study period of 28 years, remarkable strides have been made in the image diagnostic procedures such as RI scinti-scan, ultrasonography and CT and the hormonal assay. The effect of this progress appeared mainly in the cases after 1972. Therefore, the 140 adrenal operations were studied by dividing the period into the early 14 and the late 14 years. During the period of the early 14 years, 77 operations were carried out, while 63 were performed in the late period. The decreased number of operations during the late 14 years was due to the fact that Cushing's disease came to be treated mostly by transsphenoidal hypophysectomy. Surgical approaches to the adrenal gland are usually classified as anterior transperitoneal and extraperitoneal including translumbar and posterior incisions. In the former period, the transperitoneal approach was indicated in 40 operations, while the extraperitoneal approach was indicated in 37. On the other hand, 53 operations were performed by the extraperitoneal procedure with only 10 transperitoneal surgical interventions in the latter period. The decreased frequency of the transperitoneal surgery in the latter period was considered due to improved preoperative techniques to localize the adrenal lesion. Operative and postoperative complications such as spleen injury, delayed wound healing and intestinal paralysis were compared with regards to the transperitoneal and extraperitoneal approaches. More complications were noted in the transperitoneal approach.(ABSTRACT TRUNCATED AT 250 WORDS)