Comparison of laparoscopic and open adrenalectomy.

UNLABELLED: Laparoscopic adrenalectomy is one of the most significant advances in the past 20 years for treating adrenal disorders. Laparoscopic adrenalectomy has been the golden standard procedure for all adrenal pathologies since it was first defined in 1992. Laparoscopic adrenalectomy is preferred and has advantages such as less postoperative pain, earlier resumption of oral intake, shorter hospital stay, earlier return to normal life and better esthetical results. In our study we compared morbidity and mortality rates of laparoscopic and open adrenalectomy cases. MATERIAL AND METHODS: In Ankara University Faculty of Medicine General Surgery department 92 cases of adrenalectomy were performed between january 2000-july 2006. The patients were evaluated for age, sex, duration of perioperative hospital stay, resumption of oral intake, duration of operation, surgical wound infection, conversion rate and complications. RESULTS: In patients who underwent laparoscopic surgery, rate of conversion to open surgery was 9.3% (4 patients). The mean operative duration in the laparoscopic adrenalectomy group was 150 minutes and the mean operative duration in the open adrenalectomy group was 120 minutes (p = 0.001). Surgical wound infection rate was 6% in the open adrenalectomy group and 2% in the laparoscopic adrenalectomy group. Mean perioperative hospital stay was 7.1 days in the open adrenalectomy group and 5.1 days in the laparoscopic adrenalectomy group. Time to resumption of oral intake was 2.42 days in the open adrenalectomy group and 1.05 days in the laparoscopic adrenalectomy group (p = 0.001). There was no perioperative mortality in none of the groups. CONCLUSION: Laparoscopic adrenalectomy is the golden standard surgical treatment for benign and selected malignant adrenal diseases. Laparoscopic adrenalectomy is a safe and effective technique and has advantages such as less postoperative pain, earlier resumption to oral intake, shorter hospital stay, earlier return to normal life and better esthetical results compared to open adrenalectomy.

Incisional hernia treatment with polypropylene graft: results of 10 years.

PURPOSE: To report herein our results of tension-free repair of large incisional hernia with polypropylene mesh using a modification of the method that was described by Usher. METHOD: Two hundred ninety-one patients who were operated on between January 1994 and December 2004 were studied. Two hundred thirty-two patients were female (79.7%), and 59 were male (20.3%). The average follow-up period was 55 months. The patients were evaluated for infection, recurrences, hematoma and seroma formation, sinuses and enterocutaneous fistula formation. RESULTS: Infection was observed in eight patients (2.7%). Graft removal due to infection was encountered only in two patients (0.6%). Recurrence was observed in six patients (2.1%). Two patients (0.6%) developed hematoma while another two developed seroma. No patient developed enterocutaneous fistula. CONCLUSION: By using our modified technique we can decrease the expected complications after tension-free repair of large incisional hernias.