Background and Objectives: Retroperitoneal laparoscopic adrenalectomy (RLA) is one of two laparoscopic procedures used to treat benign and malignant adrenal diseases. Obesity in patients undergoing minimally invasive adrenal surgery is a frequently discussed topic. Our meta-analysis aimed to provide updated evidence by comparing intraoperative and perioperative outcomes on non-obese (NOb) and obese (Ob) patients who underwent RLA due to benign or malignant disease. Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE, Scopus, Web of Science (Science and Social Science Citation Index), and Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL)) databases were used to identify articles of interest. The meta-analysis was performed using RevMan [Computer program] Version 5.4. Results: The four included comparative studies (809 patients: 552 NOb versus 257 Ob) covered an approximately 15-year-study period (2007–2022). All the included studies were observational in nature. By comparing the Ob and NOb groups, shorter operative time and lower overall postoperative complication rates in the NOb population were recorded through the meta-analysis. Considering the subgroup analysis (BMI ≥ 30 kg/m²), just the operative time maintained statistical significance. Conclusions: Obesity did not appear to impact RLA safety and effectiveness. Due to important biases (small overall sample size and few analyzed events), the interpretation of our results must be a careful one. Later randomized and multi-center trials may help the confirmation of our results.

Background: Metabolic syndrome (MetS) is a common comorbidity associated with hypertension that occurs more often in primary aldosteronism (PA). Our work aims to investigate the prevalence of MetS and its determinants in unilateral PA and bilateral PA, as confirmed by adrenal venous sampling (AVS). Methods: This was a retrospective, cross-sectional study. We investigated metabolic indicators in 160 cases of PA, categorized by AVS—82 with unilateral PA and 78 with bilateral PA. A control group of 80 non-PA patients with essential hypertension, matched for age and sex, was also included. Results: Unilateral PA had a higher aldosterone–renin ratio and lower serum potassium levels than bilateral PA. Nevertheless, bilateral PA exhibited a higher prevalence of MetS (41% vs. 30.5%; p = 0.001), obesity, BMI, LDL hypercholesterolemia, and hypertriglyceridemia than unilateral PA. Conclusions: Bilateral PA presents a greater incidence of MetS than unilateral PA, in spite of the latter showing a higher aldosterone–renin ratio and lower serum potassium levels. The results suggest that the mechanisms underlying MetS may differ between unilateral and bilateral PA.