Laparoscopic management of primary aldosteronism: a report of 227 cases

Objective To evaluate clinical significance of laparoscopic adrenalectomy for treatment of primary aldosteronism.Methods From Jan.1999 to Dec.2009,227 patients(92 males and 135 females)with a confirmed diagnosis of primary aldosteronism underwent laparoscopic adrenalectomy.The median age was 42years old,ranging from 22 to 69 years old.The median disease duration was 4.6 yeas,ranging from 2 months to 15 years.5 cases underwent peritoneal laparoscopic adrenalectomy and 222 cases underwent retropefitoneal laparoscopic adrenalectomy.All cases had hypokalemia,hpertension,high plasma aldosterone and low plasma rennin preoperatively.Of all the cases,there were 205 cases with aldosterone-producing adenomas among whom 80 cases underwent total adrenalectomy and 125 cases underwent partial adrenalectomy.There were 22 cases with unilateral adrenal hyperplasia and all of them underwent total unilateral adrenalectomy.Results Procedures were successfully performed in all the 227 cases.The operation duration ranged from 15 to 156 min(39 min as the median)and the blood loss ranged from 5 to 220 ml(20 ml as the median).The hospitalization time ranged from 5 to 9 days (6.9±1.2 days as the median).All the cases were followed up from 6 months to 2 years(1.2 years as the median).Postoperative potassium level resumed normal in all cases.Blood pressure resumed normal in 180 cases(80%).No adrenocortieal insufficiency and any other complication occurred.Conclusion Retropreitoneal laparoscopic partial or total adrenalectomy for treatment of primary aldosteronism is a safe and feasible procedure. Key words: Hyperaldostemnism; Laparoscopy; Adrenalectomy