One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach

INTRODUCTIONThe advances in laparoscopic surgical technique and the greater experience of surgical teams have enabled the combination of different surgical techniques in a single procedure. This paper presents a case of a sleeve gastrectomy and a left adrenalectomy by laparoscopy for a morbidly obese patient with Cushing's syndrome.PRESENTATION OF CASEA 52 year-old male patient with a BMI of 53 kg/m2 was diagnosed as having Cushing's syndrome caused by a left adrenal tumor. Sleeve gastrectomy was performed according to the usual technique. The adrenalectomy was performed at the same time by a left supragastric approach. The evolution was favorable, with 52% of excess weight loss observed after six months. Plasma and urinary cortisol at the 3- and 6-month follow-ups were under normal range and the patient required glucocorticoid therapy, confirming the cure of Cushing's syndrome.DISCUSSIONTeams with experience of advanced laparoscopic surgery can successfully combine complex procedures in one surgical period. The approach we used for the adrenalectomy proved itself to be feasible after the sleeve gastrectomy.CONCLUSIONBoth procedures can be safely done in experience teams. Sleeve gastrectomy facilitates the direct supragastric approach.