Open adrenalectomy surgery: an obsolete technique? About a case of Conn's syndrome.

The authors report a case of an adenoma of Conn brought to their attention and treated by them in open surgery. The forms of primary hyperaldosteronism are essentially referable: 1) to the adenoma producing aldosterone, responsive to the ACTH, which represents the most common form (60-70%), responsive to surgery and with full recovery (70%) of cases. 2) to the bilateral hyperplasia, responsive to the angiotensine II, 25-30% of the cases, susceptible to medical therapy with receptorial antagonists of aldosterone. The diagnosis, based on the suspected clinical symptomatology, is determined by laboratory and imaging studies. Laparoscopic surgery is the orientation for this pathology. Comparative studies have shown that laparoscopic surgery adopted by experienced surgeons can treat the adrenal pathology in a mininvasive way, with good results for effectiveness and safety, and for these reasons the laparoscopic treatment is considered the gold standard for this pathology. But adrenal pathology is rare, 4% in people suffering hypertension, and from 0.35 to 4.4% in tumours. There are, however, only a few medical centres which have the possibility of observing a high number of such a pathology with a consequent accepted learning curve for laparoscopic treatment. For this reason the authors believe that "open" surgery in adrenal pathology is not obsolete and that surgical teams which have experience in retroperitoneal pathology must intervene adopting a laparotomic approach, with the aim to operate the sick person, who totally confides himself to the surgeon, in an appropriate way.