What is adrenalectomy?
An adrenalectomy is surgery to remove one or both adrenal glands.
There is an adrenal gland resting on each of the kidneys. The two adrenal glands produce various hormones that help regulate metabolism, the immune system, blood pressure, blood glucose, and other essential functions.
Most adrenal tumors are noncancerous (benign). You may need surgery (adrenalectomy) to remove an adrenal gland if the tumor produces excess hormones or is large in size (greater than 4 to 5 centimeters). If you have a cancerous (malignant) tumor, you may also need an adrenalectomy. This malignant tumor can come from the adrenal gland itself or from another organ, such as the kidney or lung.
If both adrenal glands are removed, you will need to take hormonal medications. If only one gland is removed, the remaining gland will take over.
Before any surgery, an assessment should be carried out by the anesthetist where they will advise you which medication you should stop taking and which you should continue taking. Sometimes you must be evaluated by another specialist if you have underlying diseases.
In the case of anticoagulant treatment or treatment that facilitates bleeding, the anesthesiologist, haematologist, cardiologist or family doctor will inform about the attitude to follow.
In the case of smoking, the habit should be stopped because it facilitates anesthetic management, smoker patients have more complications than smokers in anesthetic procedures.
It is recommended to perform moderate-intensity exercise before any intervention, unless there is a specific contraindication, such as walking at least 60 minutes a day.
Sometimes, after a detailed study by the endocrinologist, you must take a specific medication to control the function of your adrenal glands. This will help better control of your vital functions by the anesthesiologist during surgery.
How is the preparation prior to the intervention?
FOOD AND MEDICINE
In preparation for an adrenalectomy, your surgeon may ask you to do the following:
- Do not eat anything before surgery. You may have a sip of water with your medications, but avoid eating and drinking for at least six hours before surgery.
- Discontinue certain medications and supplements. Talk to your doctor about all medications and supplements you take. You continue to take most medications as directed by your doctor. Your doctor may ask you to stop certain medications and supplements because they can increase your risk of bleeding.
- Take certain drugs. Your doctor may prescribe a specific medication to take a few days before the procedure to control the function of your adrenal glands.
How is the surgery performed? (type of incision, resection, type of drainage, anesthesia).
BEFORE THE INTERVENTION
An adrenalectomy is performed under general anesthesia, so you will not be conscious during the procedure. Numbing medications are given intravenously into the arm. Once the medications take effect, the health care team will insert a tube down your throat to help you breathe. Your surgeon will perform the adrenalectomy using a laparoscopic or open procedure.
DURING THE PROCEDURE
Depending on your situation, your surgeon will recommend one of two surgical approaches:
Minimally invasive (laparoscopic) adrenalectomy
During a laparoscopic adrenalectomy, the surgeon makes four or five small incisions in the abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. The surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in the abdomen to remove the adrenal gland. The incisions are then sutured and you are transferred to a recovery area and sometimes to an intensive care unit if the indication for surgery is because your adrenal glands produce excess hormones. A laparoscopic adrenalectomy takes one to two hours.
A laparoscopic adrenalectomy is not appropriate for everyone. In some cases, the surgeon may start with a laparoscopic approach and determine that a larger incision is necessary due to scar tissue from operations, previous complications, or an inability to safely continue with the procedure.
Traditional (open) adrenalectomy.
Doctors usually reserve open surgery for large or cancerous (malignant) tumors.
During an open adrenalectomy, the surgeon makes an incision about 15 centimeters in the abdomen below the ribs on the side where the diseased gland is located. Muscle and tissue are retracted to reveal and remove the adrenal gland. On the right side it is located below the liver and on the left, behind the pancreas.
The incision is sutured and you are taken to a recovery area. An open adrenalectomy takes about two hours. It is usually performed when the procedure cannot be carried out with maximum safety through the laparoscopic approach.
Sometimes it is necessary to place a tube or drain inside the abdomen with an outlet through the skin to allow the discharge of fluid from the area where the adrenal gland was. This tube will be removed prior to discharge home.
What happens after the surgery?
After surgery, the patient slowly awakens from the effects of the anesthetic drugs, so they may have a feeling of not remembering the process. He will spend a short period of time in an area called post-anesthetic recovery, before being taken to his room.
HOW IS THE RECOVERY IN THE HOSPITAL?
It is possible to feel nausea or abdominal pain after the intervention but they will be controlled with the prescribed medication. After about 6 hours, you will begin with the intake of liquids and then solid foods. We recommend sitting down and starting to walk about 8-12 hours after the intervention. You will be supervised at all times by nursing staff.
It will usually go away in one or two days after the intervention.
HOW IS THE RECOVERY AT HOME?
Our premise is to be active in recovery. For this reason, we encourage the patient to walk daily, we recommend walking at least 60 minutes each day both inside and outside the house. Important physical efforts that may affect wound healing should always be avoided.
When you are discharged home, you will be prescribed medication to make you feel as comfortable as possible. You will resume your previous medication following the surgeon’s recommendations, since some drug may not be recommended in the first days after surgery. Normally the taking of painkillers is indicated to control the pain and the injection of heparin to avoid the appearance of thrombi in your legs.
In relation to food, we recommend the first week to avoid copious meals. Later you could eat your usual diet before the intervention.
You can wet your wounds when you wash yourself and then gently dry them with the application of any antiseptic (chlorhexidine, povidone-iodine, crystalmine…). These wounds should be evaluated by nursing around 7 and 10 days after surgery.
Virtually full recovery can take approximately two to three weeks for laparoscopic adrenalectomy. However, with open adrenalectomy, once at home, full recovery may take four to six weeks.
What are the risks of adrenalectomy?
The normal thing is that your intervention proceeds without incidents but you must know the potential complications.
Less serious and frequent risks: Infection or bleeding of the surgical wound. Phlebitis. Urinary retention. Transient digestive disturbances. Prolonged pain in the area of the operation. Pleural effusion. Laparoscopic surgery may cause gas extension to the subcutaneous tissue or other areas and referred pain, usually to the shoulder.
Infrequent and serious risks : Bleeding or intra-abdominal infection. Intestinal obstruction. Cardiocirculatory and hydroelectrolytic alterations due to changes in hormonal levels. Disease recurrence. Due to laparoscopic surgery, there may be vascular injuries, injuries to neighboring organs, gas embolism and pneumothorax.
These complications are usually resolved with medical treatment (medicines, serums, etc.), but they may require a reoperation, usually an emergency, and in exceptional cases death may occur.
Your risk of complications depends on your overall health and the reason you’re having an adrenalectomy.