Evolution of Minimally Invasive Adrenal Surgery at a Tertiary Care Centre in Oman

Objective: We reviewed the case records of adrenalectomy cases at our institution between January 2010 and December 2020 and report the outcomes of both open and laparoscopic adrenalectomy (LA). Methods: This retrospective study included patients who underwent adrenal surgery from January 2010 to December 2020. We recorded demographic details, indications, surgical approach, intra operative data and complications. The final pathology and outcome at the last follow up was also documented. Data was analyzed through the SPSS program. Results: Fifty two patients underwent 61 adrenalectomy procedures. Six patients had bilateral procedure and 3 patients underwent redo surgery accounting for 55 subjects. Open adrenalectomy (OA) was performed on 11 patients and 44 patients underwent LA. Majority of the patients (27) were obese having BMI > 30. Functional adenoma was excised in 36 patients with final diagnosis of Conn’s syndrome in 15, Pheochromocytoma in 13 and Cushing syndrome in 9 patients. Five patients had surgery for oncological indications. Nonfunctional adenoma was excised in 13 patients, with a mean size of 8.9 cm (range 4-15 cm). The mean duration of surgery was less in laparoscopic procedure (199 min) compared to open (246 min). The mean estimated blood loss in LA was significantly less (108ml vs 450 ml, p-value < 0.05). Out of 55 subjects only 1 patients developed Clavien-dindo grade 2 complication. Conclusion: At our institution both laparoscopic and open adrenalectomy were safely performed. There is a trend to perform LA and with experience the duration of surgery and EBL are demonstrating positive trend. Keywords: Adrenal Gland Surgery; Laparoscopic Adrenalectomy; Open Adrenalectomy; Pheochromocytoma; Adrenal Metastasis; Nonfunctional Adrenal Tumors; Oman

Renal graft intolerance syndrome in late graft failure patients: efficacy and safety of embolization as first-line treatment compared to surgical removal

International audienceAlthough renal graft percutaneous embolization was introduced to avoid the risk associated with graft nephrectomy, there is no universal consensus about its indications and results. In order to evaluate the efficacy of graft embolization in the treatment of graft intolerance syndrome as well as its safety compared to surgical removal with respect to complications and other morbidity measures, We performed a retrospective observational study comparing two groups of patients treated for graft intolerance syndrome: Group 1: patients who had embolization as first-line treatment and Group 2: patients directly treated by surgical removal. 72 patients were included, (32 in Group 1 and 40 in Group 2); the postintervention follow-up continued for 12 months. Patients in Group 1 are older than those in Group 2. Otherwise, the two groups are similar concerning sex, manifestations of graft intolerance syndrome, diabetes and nutritional and functional status. The overall success rate of embolization in complete resolution of graft intolerance syndrome and ultimately avoidance of surgical removal was 84.37%. The surgical removal group had more serious complications, a longer hospital stay and needed more blood transfusions. We conclude that embolization of symptomatic renal grafts has considerable efficacy with less morbidity, and no serious complications compared to the standard surgical graft removal

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population