It is unclear how sex disparities affect surgical outcomes following retroperitoneal laparoscopic adrenalectomy (RLA). Therefore, we studied whether gender could affect RLA outcomes perioperatively. A retrospective study was performed involving consecutive cases underwent unilateral RLA for adrenal disease from January 2012 to December 2021. Coarsened exact matching (CEM) was applied to balance patient groups. Logistic regression analysis was performed to assess the impact of sex on prolonged operative time and increased intraoperative blood loss. A total of 569 patients who underwent RLA were included. After CEM, 112 patients were incorporated in each group. Operative time (male: 129.47 vs. female: 95.53, P < 0.001) and intraoperative blood loss (male: 123.39 vs. female: 101.61, P = 0.009) differed statistically significantly, while equal postoperative length of stay (LOS) (6.7 d vs. 6.8 d, P = 0.686), drainage tube removal time (3.0 d vs. 3.0 d, P = 0.231) and incidence of Clavien-Dindo grade ≥ 2 perioperative complications (8.0
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