Re: Synchronous bilateral adrenalectomy by midline incision: A reliable method for treatment of hypercortisolism.

Sir,

After I read the Letter to Editor[1] (Synchronous bilateral adrenalectomy by midline incision: A reliable method for treatment of hypercortisolism) and Letter to Editor[2] Re: Tabatabaee et al. in JRMS, I found some studies which may be useful in this regard..

Bilateral adrenalectomy either by open (BOA) or laparoscopic (BLA) approach remains a safe and definitive management for corticotrophin (ACTH)-dependent Cushing’s syndrome.

Open adrenalectomy remains a consideration when concomitant intra-abdominal procedures are necessary in select patients with ectopic ACTH syndrome, or when laparoscopic techniques are either inappropriate or unavailable.[3]

To date, there is a few published information that directly compares open and laparoscopic approach of bilateral adrenalectomy.

Laparoscopic procedure for adrenalectomy has become widely accepted since its initial description in 1992.[12]

Although Propilia et al. (2004)[4] and Acosta et al. (1999)[5] found no difference in complications and in the length of hospital stay between BOA and BLA procedures, respectively, more numerous recent reports have demonstrated that laparoscopic adrenalectomy is associated with a shorter hospital stay, faster recovery, improved patient satisfaction, lower morbidity rate, favorable outcomes, and fewer perioperative complications (especially, wound related) than open adrenalectomy.[6-17]

Additionally, postoperative analgesic requirements have been shown to be significantly less, following BLA when compared with BOA.[3]

The overall rates for mortality and complications from the 12 series are 2.4% and 13%, respectively.[1819]

Hence, in experienced centers, BLA is safe and effective; more often avoiding problems associated with open approaches these being especially problematic in the patients with hypercortisolism.[3]

This review indicates that BLA is gaining popularity and being done more commonly at institutions worldwide.

Although this report (Re: Letter to Editor) does not prove or disprove the use of BLA, it provides data for clinicians to use to weigh risks and benefits appropriately. It further provides strong data toward entertaining the possibility of laparoscopic approach for total adrenalectomy as the treatment of choice for ACTH-dependent Cushing’s syndrome.