Abstract:

Objective   To evaluate differences in peri-operative and long-term results between laparoscopic partial and total adrenalectomy for aldosterone-producing adenoma. Methods   The clinical data from 103 patients with primary aldosteronism caused by aldosterone-producing adenoma between April 2004 and June 2009 were retrospectively analyzed. 69(67%) patients underwent laparoscopic partial adrenalectomy(LPA) and 34(33%) underwent laparoscopic total adrenalectomy(LTA). Results   All procedures were successfully finished by laparoscopy, without conversion to open surgery. No major intraoperative or postoperative complications were observed. There was no significant difference between LPA and LTA in duration of surgery, intra-operative blood loss, mean hospital stay after operation, complications, and postoperative plasma potassium and aldosterone(all P>0.05). During a median of 37(9-82) months of follow-up, there was no remarkable difference in prognosis of blood pressure: 44 cases were cured, 24 cases were improved, and 1 case failed in LTA; while 21 cases were cured, 9 cases were improved, 4 cases failed in LPA. 3 cases with LPA had  blood pressure improved after operation, but  high blood pressure associated with high plasma aldosterone -recurred after 8 months, 1.5 years and 3 years. Postoperative plasma potassium and aldosterone were within normal ranges in the other 100 cases 6 months after operation. Conclusion    There is no significant difference between LPA and LTA in duration of surgery, intraoperative blood loss, mean hospital stay after operation, complications, and postoperative adrenocortisol deficiency rate and improvement of blood pressure. Given the recurrence possibility of aldosterone-producing adenoma by LPA, the curative effect of LTA is comparatively more definite. So LTA is recommended for unilateral aldosteroneproducing adenoma.

Key words: Primary aldosteronism; Laparoscope; Partial adrenalectomy; Unilateral total adrenalectomy; Hypertension