Adrenal Surgery

The most common reason for adrenal surgery is for a tumour of the adrenal gland. The majority of these tumours are not cancers but a few of them are. Most adrenal tumours are discovered incidentally, do not produce hormones and are asymptomatic. Occasionally, these tumours secrete excessive quantities of hormone resulting in physiological disturbances in the body. The most commonly overproduced hormones are cortisol, aldosterone and noradrenaline.

Laparoscopic adrenalectomy is a minimally invasive method to remove the adrenal gland. Most adrenalectomies can be done this way. It is associated with a significantly shorter hospital stay, less post-operative pain, earlier return to daily activities and a better functional and cosmetic result to that of open surgery.

Prior to your operation you may need to attend a Preadmissions Clinic. Your fitness for surgery will be assessed, tests may be ordered and referrals to other specialists arranged if required.

You cannot eat for 6 hours prior to your operation. You may sip water for up to 2 hours prior to your operation. Fasting decreases the risk of vomiting and aspiration during induction of anaesthesia. Aspiration can cause pneumonia and a prolonged stay in hospital.

Laparoscopic adrenalectomy is done under general anaesthesia. You will be asleep during the whole procedure. The anaesthetist will discuss the anaesthetic with you prior to your operation. They will see you in the pre-operative area and accompany you to the operating theatre.

Following general anaesthesia, you are positioned on your side on the operating table. The operative approach is via 4 small (5mm) incisions in the abdominal wall. An operating telescope and instruments are passed through these incisions and the adrenal gland is dissected free. It is then removed in a plastic sac via an extension of one of the incisions. At the end of the operation, the skin is closed with absorbable sutures and dressed with transparent lilac coloured glue and a transparent dressing. The whole operation takes 1.5-2 hours.

Following the operation, you will wake up in the recovery area. You will feel a little disoriented and may feel a little nauseous. The staff in recovery are equipped to help you. Immediate post-operative pain is usually minimal. Once you are awake and oriented, you will be taken to a ward bed. After a few hours, and once the nurses are satisfied that it is safe, you can get out of bed.

Most patients who have a laparoscopic adrenalectomy spend one or two nights in hospital. Post-operative pain is managed by the pain team with intravenous and then oral analgesia.

Once you can tolerate an oral diet, your pain is controllable with oral analgesia and you feel confident enough, you can go home. Please do not drive yourself home from the hospital but rather arrange a family member or friend to come and pick you up.

There are no dietary restrictions or special dietary supplements that are required after adrenal surgery. You may eat whatever you choose. You may bathe and shower. The wound is waterproof and can get wet.

You should avoid strenuous physical activity for four weeks after your operation. It increases the risk of post-operative pain and wound hernia which could result in an emergency trip back to the hospital. Once this period has passed and you feel that you have recovered, you may return to your normal physical activities.

There is no specific law covering surgery and driving. It is not advisable to drive immediately after surgery. In general, in order to return to driving, you must:

1. Have a valid drivers’ licence
   
2. Be able to control your vehicle during an emergency
   
3. Be able to testify in court as to your capacity to drive

Your car insurer may not cover you following an accident if:

1. You have had recent surgery (‘recent’ is not clearly defined)
   
2. You are taking pain or sedative medications that may impair your concentration or judgement

Aim to return to driving when:

1. You are pain free
   
2. You have full range of motion
   
3. You are not taking strong pain medications or sedatives
   
4. Your reaction time is not compromised

If you are in doubt, do not drive. Call your insurer for advice.

  - Driving Safety and Medicines PDF
NSW Government fact sheet

Post-operative swelling around the wound is normal and usually resolves within a month or so. No specific wound management is needed in the first two weeks while the dressings are on. After this, gentle scar massage is advisable for 10 minutes two or three time a day for 6 months. You may use whatever moisturising lotion you like (e.g. sorbolene, bio-oil etc.) but creams with Vitamin E should be avoided for the first post-operative month. Alternatively, you can keep the scar covered with a silicon strip for 12 hours a day for 6 months. These strips are available from the chemist but are quite costly.

Initially the scar will be pink. Over 6-12 months, the scar will fade until it becomes pale.

Complications of adrenal surgery are uncommon.

Bleeding
This occurs in <5% patients and can usually be controlled laparoscopically. Occasionally conversion to an open operation is required. The need for a blood transfusion is rare.

Wound Infection
These can complicate any type of surgery and can usually be treated with a short course of oral antibiotics. Uncommonly, IV antibiotics or further surgery is required.

Damage to Surrounding Organs
This is an uncommon event but can complicate any type of surgery. Organs in the vicinity of the adrenal glands include bowel, kidney, pancreas, stomach, spleen, liver and vascular structures. If they are damaged, another operation is often required to repair them.

Incisional Hernia
Hernias at incision sites are an uncommon but recognised complication of laparoscopic surgery. They more commonly occur with open surgery. If they do occur, another operation is usually required to repair them.

Open Adrenalectomy
Open adrenalectomy is sometimes required for large tumours or if a patient has had abdominal surgery making a laparoscopic approach impractical. Occasionally, complications can be encountered during a laparoscopic adrenalectomy, making completion of the operation difficult. Conversion to open adrenalectomy is then required. The larger incision will mean a longer recovery period.

A follow-up appointment should be arranged in rooms 2 weeks after your operation for a discussion regarding pathology. Another appointment will be required 4-6 weeks after surgery for a post-operative check-up. At this appointment, your wounds will be assessed, and any further investigations and management arranged. Please call to arrange a convenient time.

If you have any questions, please do not hesitate to contact us.

Ph: 02 8307 0977
Fax: 02 8088 7420
Email: info@drgideonsandler.com