Laparoscopic adrenalectomy for Conns syndrome benefits is beneficial to patients and to health finances
Heather White, Samantha Jayaweera, Gregory Sadler & Radu Mihai
Background: Primary hyperaldosteronism is allegedly present in 10% of hypertensive patients. Conns syndrome is present in a third of such patients and adrenalectomy has the potential to cure/improve the control of hypertension. This study assesses the benefits/costs of laparoscopic adrenalectomy (LA) in a cohort of consecutive patients with Conns syndrome operated in a tertiary referral centre.
Methods: Clinical, radiological, operative and pathological data were collected on patients undergoing adrenalectomy for Conns syndrome over a 6 years period.
Results: Between Jan 05 and Oct 10 a total of 24 patients (9M:15F, age 3475 years, median 51 years) underwent LA for Conns syndrome. Localisation of the adenoma was based on results of CT scans (n=19), MRI scans (n=6) and selective adrenal venous sampling (n=17). Uneventful LA was performed in 21 patients and three patients needed conversion to open operation. Mean operative time was 80 min (range 20125 min) and mean postoperative stay was 2±1.4 days (range 17 days, mode 1 day). Hospital costs were calculated to be £9180 for radiological investigations, £7920 for outpatient assessment, £14 100 for in-hospital stay, £30 000 for operating theatre use and £12 000 for disposable surgical instruments. These costs averaged to £3050/patient, that is within the national tariff for adrenalectomy (HRGKA04z=£3333).
Follow-up by postal questionnaire in September 2010 had a response rate of 61% (14 of 23 patients) at a mean post-operative time of 37±4 months. 93% (13 of 14) patients reported taking no/fewer anti-hypertensive medications, with each patient being prescribed two fewer medications on average. 86% (12 of 14) patients reported improved quality of life post-operatively (10-point scale) and all patients stated that they would definitely have the operation again in preference to anti-hypertensive medications.
Conclusion: Laparoscopic adrenalectomy for Conns syndrome has a positive impact on blood pressure control and quality of life of patients. This diagnostic and therapeutic protocol is cost-effective.