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. 2014;5(1):22-5.
doi: 10.1016/j.ijscr.2013.11.008. Epub 2013 Nov 19.

One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach

Amador G Ruiz de Gordejuela  1 , Jordi Pujol Gebelli  2 , Núria Vilarrasa García  3 , Lluis Secanella Medayo  2 , Araceli Estepa Marín  4 , Anna Casajoana Badía  2
Affiliations

One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach

Amador G Ruiz de Gordejuela et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: The advances in laparoscopic surgical technique and the greater experience of surgical teams have enabled the combination of different surgical techniques in a single procedure. This paper presents a case of a sleeve gastrectomy and a left adrenalectomy by laparoscopy for a morbidly obese patient with Cushing's syndrome.

Presentation of case: A 52 year-old male patient with a BMI of 53kg/m(2) was diagnosed as having Cushing's syndrome caused by a left adrenal tumor. Sleeve gastrectomy was performed according to the usual technique. The adrenalectomy was performed at the same time by a left supragastric approach. The evolution was favorable, with 52% of excess weight loss observed after six months. Plasma and urinary cortisol at the 3- and 6-month follow-ups were under normal range and the patient required glucocorticoid therapy, confirming the cure of Cushing's syndrome.

Discussion: Teams with experience of advanced laparoscopic surgery can successfully combine complex procedures in one surgical period. The approach we used for the adrenalectomy proved itself to be feasible after the sleeve gastrectomy.

Conclusion: Both procedures can be safely done in experience teams. Sleeve gastrectomy facilitates the direct supragastric approach.

Keywords: Cushing's syndrome; Left adrenalectomy; Morbid obesity; Sleeve gastrectomy.

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Figures

Fig. 1
Fig. 1
CT-scans show the abnormal left adrenal gland.
Fig. 2
Fig. 2
Trocar position for the procedure.
Fig. 3
Fig. 3
Surgical field after the sleeve gastrectomy and prior to the adrenalectomy.
Fig. 4
Fig. 4
Dissection of the diaphragmatic–adrenal channel.
See this image and copyright information in PMC

References

    1. Shikora S.A. Severe obesity: a growing health concern A.S.P.E.N. should not ignore. J Parenter Enteral Nutr. 2005;29(July–August (4)):288–297. - PubMed
    1. Fleseriu M., Ludlam W.H., Teh S.H., Yedinak C.G., Deveney C., Sheppard B.C. Cushing's syndrome might be underappreciated in patients seeking bariatric surgery: a plea for screening. Surg Obes Relat Dis. 2009;5(January–February (1)):116–119. - PubMed
    1. Guh D.P., Zhang W., Bansback N., Amarsi Z., Birmingham C.L., Anis A.H. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88. - PMC - PubMed
    1. Hamad G.G. The state of the art in bariatric surgery for weight loss in the morbidly obese patient. Clin Plast Surg. 2004;31(October (4)):591–600. vi. - PubMed
    1. Micali S., Peluso G., De Stefani S., Celia A., Sighinolfi M.C., Grande M. Laparoscopic adrenal surgery: new frontiers. J Endourol. 2005;19(April (3)):272–278. - PubMed