Clinical predictors and significance of adherent periadrenal fat in laparoscopic adrenalectomy

BACKGROUND: Adrenalectomy requires the anatomic preparation of the adrenal gland in the fat-rich retroperitoneal space. In the literature, it was shown that the retroperitoneal fat area affects surgical outcomes in laparoscopic adrenalectomy (LA). Besides the quantity of retroperitoneal fat, its qualitative properties play hypothetically a significant role in the safety profile and perioperative parameters of LA. In this study, we aimed to evaluate the factors associated with adherent periadrenal fat. METHODS: The prospectively obtained demographic, preoperative, intraoperative, and postoperative data of 44 patients who underwent laparoscopic adrenalectomy in our clinic were analyzed retrospectively. The patients were divided into two groups as adherent periadrenal fat (APAF) and non-APAF group. Periadrenal fat tissue was defined as adherent or non-adherent by the attending surgeon according to the difficulty in dissection of the adrenal gland from the surrounding fat tissue during the operation. RESULTS: The rate of female gender and presence of diabetes mellitus (DM) was higher in the APAF group (respectively, p = 0.038 and p = 0.001). A ROC curve analysis showed that the cut-off point was − 97 HU for APAF. On multivariable analysis using a stepwise regression model, we identified the presence of DM (OR = 5.073; 95% Cl = 2.192–12.387; p = 0.006) and ARFD > -97 HU (OR = 3.727; 95% Cl = 1.898–11.454; p = 0.008) as an independent predictor of APAF. CONCLUSION: APAF seems to affect the perioperative outcomes of LA in terms of operation duration but not perioperative complications.