Retroperitoneal vs. transperitoneal laparoscopic adrenalectomy: a meta-analysis of the literature

Abstract

Minimally invasive surgery is becoming the mainstay of surgical treatment. Two laparoscopic techniques have been developed in the management of adrenal disease—retroperitoneal and transperitoneal laparoscopic adrenalectomy. A literature search has been carried out in PubMed, MEDLINE, EMBASE and Google Scholar academic search engines, using the MeSH terms “Adrenalectomy”, “Randomised Controlled Trials”, “Retroperitoneal”, “Transperitoneal”, “Laparoscopy”. All randomized controlled trials published until January 2016 comparing retroperitoneal and transperitoneal laparoscopic adrenalectomy were identified. Data were collected on operative performance, operative time and post-operative management. Each outcome was calculated with 95% confidence intervals (CI). Three blinded prospective randomised controlled studies were used. When compared to transperitoneal laparoscopic adrenalectomy, retroperitoneal laparoscopic adrenalectomy has comparable blood loss (χ2 = 11.24; P = 0.0008; CI −2.67, 6.73; I2 = 91%), operative time (χ2 = 5.77; P = 0.06; CI −0.41, 3.19; I2 = 65%) and post-operative pain (χ2 = 1.31; P = 0.25; CI −0.5, 1.33; I2 = 24%). Retroperitoneal laparoscopic adrenalectomy is associated with a significantly shorter time to oral intake (χ2 = 7.56; P = 0.006; CI 1.93, 5.13; I2 = 87%), ambulation (χ2 = 0.09; P = 0.77; 2.64, 8.58; I2 = 0%) and hospital stay (χ2 = 2.23; P = 0.14; CI 0.44, 1.68; I2 = 55%). Retroperitoneal laparoscopic adrenalectomy is significantly better than transperitoneal laparoscopic adrenalectomy with regards to time to oral intake, ambulation and hospital stay. There is no significant difference between the two with regards to blood loss, operative time and post-operative pain.