Postoperative Recovery and Hospital Stay following Laparoscopic Adrenalectomy for Small and Large Adrenal Tumor

Résumé

Introduction: Laparoscopic adrenalectomy is the most successful therapy for a small adrenal tumour (LA). However, due to the likelihood of technical difficulties and malignant potential, the use of laparoscopic adrenalectomy (LA) in the treatment of large tumors remains debatable. The purpose of this study was to evaluate if there was a relationship between the size of the adrenal tumour and the feasibility of laparoscopic adrenalectomy at a tertiary care centre. Objective: To observe the postoperative recovery and hospital stay in adrenal tumor in laparoscopic adrenalectomy. Methods: 32 patients with adrenal tumors who had unilateral transperitoneal LA at the Department of General Surgery of Bangabandhu Sheikh Mujib Medical University from January 2021 to December 2022 were included after convenience selection and divided into two groups based on tumor size. Patients in groups I and II each had tumors that were less than 5 cm in size (n = 15 and 17 respectively). A comparison of the groups' demographic information, perioperative outcomes, complications, and pathologic reports was made. In order to determine how the size of the adrenal tumor affected the safety and effectiveness of laparoscopic adrenalectomy, data were analyzed using SPSS version 23. Chi-square (2) test and unpaired t test were performed. Result: In group-I, 66.67 % of patients were below 50, and in group-II, 64.71%. In group-I, the mean age was 34.16±9.61 and in group-II, 35±10.23. In group-I (53.33%) and group-II (52.94%), most patients were male. Age and sex variations across groups weren't significant (p>0.05). All (100%) patients in group-I had a BMI 30 kg/m2 and 10 (58.82%) in group-II. Group- I's mean BMI was 25.97±2.03kg/m2 and group-was II's 25.94± 3.29kg/m2. BMI differences across groups were non-significant (p>0.05). In group-I, 40.0% of patients had HTN, and in group-II, 41.18%. 33.33% of group-I patients and 23.53% of group-II patients had DM. Two (13.33%) patient in group-I had CKD, (6.67%) hypothyroid, and (6.67% ) medullary thyroid cancer. 17.65% in Group II had CKD, (11.76%) hypothyroid and (5.88%) hepatitis B. Co-morbidities didn't differ between groups (p>0.05).   Almost two third 9(60%) of patients had left site tumour in group-I and 9(52.94%) in group-II. The mean tumour size was 2.41±0.17 cm in group-I and 4.98±0.13 cm in group-II. 6(40.1%) of patients had functioning tumor in group-I and 4(23.53%) in group-II. Conclusion:Laparoscopic transperitonealadrenalectomy forsmall (<5 cm) and large (≥5 cm) adrenal tumors that are attainable and is not associated with significant intraoperative problems other than blood loss, postoperative issues and recuperation. The key to a successful laparoscopic surgery on a big adrenal tumour is the cautious selection of the patient and the use of an adrenal-trained surgeon.