Bora SOLMAZ, Gülce HAKGÜDER, Oğuz ATEŞ, Mustafa OLGUNER, Feza M. AKGÜR

Çocuk olgularda laparoskopik transperitoneal adrenalektomi deneyimlerimiz

Amaç: Endoskopik adrenalektomi, benign, iyi sınırlı adrenal kitlelerin tedavinde erişkinlerde altın standart haline gelmiştir. Çocukluk yaş grubunda endoskopik adrenalektomi yapılan olgu sayısı sınırlıdır. Çocukluk yaş grubunda transperitoneal laparoskopik adrenalektomi deneyimlerimizi sunmak istiyoruz. Gereç ve Yöntem: 1998-2008 yılları arasında 'adrenal kitle' tanısıyla laparoskopik transperitoneal adrenalektomi uygulanan 4 hastanın (1 erkek, 3 kız) dosya ve dijital video kayıtları geriye dönük olarak incelendi. Bulgular: Yaşları 1 ile 18 (ortalama 6 ± 5) arasında değişen 4 hastaya laparoskopik adrenalektomi uygulandı. Hastaların vücut ağırlıkları 8 ile 65 kg arasında (ortalama 25 ± 17) değişmektedir. Kitlelerin 2 tanesi sağ, 2 tanesi de sol adrenal bez yerleşimliydi. Ameliyat süreleri 160 ile 190 dakika (ortalama 175 ± 15) arasında değişmektedir. Histopatolojik incelemede nöroblastom (n=1), ganglionöroblastom (n=1) ve adrenal adenom (n=2) saptandı. Hastaların ameliyat sonrası hastanede kalış süresi 2-3 gündür (ortalama 2,5 ± 0,5). Hastaların izlem süresi ortalama 2 yıldır. Nöroblastom tanılı hasta halen izlemdedir. Sonuç: Laparoskopik adrenalektomi, çocukluk çağı adrenal tümörlerinin tedavisinde giderek tercih edilen bir tedavi yöntemi olmaktadır. İyi sınırlı adrenal tümörlere yaklaşımda, daha erken ağızdan beslenmeye geçilmesi, daha az ağrı ve daha küçük cerrahi keşi avantajları ile laparoskopik adrenalektomi ilk seçenek olarak düşünülmelidir.

Laparoscopic transperitoneal adrenalectomy experiences in the pediatric patients

Objective: Endoscopic adrenalectomy has become a gold standart in the treatment of benign and well defined adrenal tumors of adult patients. The number of patients underwent laparoscopic adrenalectomy is limitted in the pediatric age group. We herein present our transperitoneal laparoscopic adrenalectomy experiences in pediatric patients. Material and Method: The hospital and digital video recordings of 4 patients (1 boy 3 girl) with 'adrenal mass' who underwent laparoscopie transperitoneal adrenalectomy were evaluated retrospectively. Results: Four patients aging between 1 and 18 years (mean 6 ± 5) during 1998 -2008 were underwent laparoscopic adrenalectomy. Their body weight were between 8 and 65 kg (mean 25 ± 17). Two of the tumors were right, the other 2 were left sided. Operating time ranged from 160 to 190 minutes (mean 175 ± 15).The histopathological examination of the masses revealed 1 neuroblastoma, Iganglioneuroblastoma, and 2 adrenal adenomas. Postoperative hospital stay was 2 to 3 days (mean 2.5 ± 0.5). The mean follow up period of the patients' was 2 years. One patient with neuroblastoma is still on follow up. Conclusion: Laparoscopic adrenalectomy has becoming a preferred procedure in the treatment of adrenal tumors in pediatric age group. Laparoscopic adrenalectomy should be the first choice in the treatment of well defined adrenal tumors as the patients start oral feedings early, have lesser pain and smaller incisions.

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