ADRENALECTOMY

The following information is for patients undergoing an operation to remove the adrenal gland.

Your time in hospital

You will be in the hospital for usually 4-6 days. You will be assessed on the ward the week before your operation. This allows us to make sure that you are fit for an operation, to do a pre-operative blood test. It also allows you to meet the junior doctors and nurses who will be looking after you during your stay on the ward. The anaesthetist, who is the doctor that will put you to sleep for the operation, will also review you. You will remain on your usual medication. After your assessment you will be allowed home and you will then come into the ward the evening before your operation. You will then be fasted (nothing to eat or drink) from midnight the night before.

Most adrenal glands can now be taken out by the keyhole method, providing they are not too big (up to about 10 cms). The keyhole method involves several little cuts on the tummy, to allow the surgeon to put a telescope and some surgical instruments into the tummy. The adrenal gland is dissected free and removed through one of the cuts using a little bag. Occasionally (about 5%) of the time, due to the awkward position of the adrenals, it is necessary for the surgeon to convert the operation, using a bigger incision, to allow better access to the adrenal.

The operation itself normally takes 1-2 hours. Following the operation you are kept in the theatre recovery area for around 3-4 hours and then returned to the ward. Some operations on the adrenal gland necessitate a short post-operative stay in the High Dependency Unit, where the doctors and nurses are able to give you a lot of individual attention to make sure that everything goes smoothly after your operation. When you wake up, there will be a drip in your arm and probably an extra drip in your neck. You will probably have a little device with a button that allows you to automatically give yourself some painkilling drugs to try to settle any pain in your tummy. There will be several little scars on your abdomen if it has been done by the keyhole method. You will be allowed to drink some fluids the same night. You are encouraged to be as active as possible, in particular, to cough and move your legs.

If you have had both your adrenal glands removed then you will be started on some steroid medication to cover the effects of you removed adrenal glands.

Your follow-up appointment

You will normally be reviewed in the endocrine outpatient clinic approximately six weeks after your operation, when you will be reviewed by the surgeon. This gives the surgeon a chance to check that your tummy wounds have all healed and to go over the results of the pathology of the adrenal gland. Further follow up will probably be required for most patients, either by the surgeon or by your original hospital physician.

Any operation can have potential risks

Any operation can have potential risks, and there are a few risks that you should know about: -

• If the operation is being done by the keyhole method, there is about a 5% chance that the surgeon cannot see the anatomy properly for various reasons and this would then require for the surgeon to go ahead and do an operation with a larger incision (an "open" operation).
  
• Sometimes you can be a little sore in your wounds after the operation and you try not to breathe too deeply, to avoid pain. This in itself can lead to a build up of secretions in your lungs, leading to a chest infection. We will try to avoid this by keeping you as comfortable as possible and getting you to do deep breathing exercises, in conjunction with the physiotherapist.
  
• There is around a 5% chance of an infection in your wound, the vast majority of which can be controlled by an antibiotic.
  
• There is about a 3% chance of significant wound bruising, which causes some swelling of the tummy cuts.
  
• After any tummy operation, there is a small risk of getting a little clot in the veins of your leg (called a DVT), because you are unable to walk and exercise as much as normally. We will try and reduce this possibility as much as we can by getting you to wear special stockings on you legs and by giving you little injections into your tummy to thin the blood. If you are on the oral contraceptive pill you should let your surgeon know, as this is best stopped at least 4 weeks before your operation.

This information goes some of the way in answering a lot of the most common questions that we get asked by patients undergoing an operation on the adrenal gland. However, you may have specific questions about the operation and we will be more than happy to answer your questions when you are admitted to hospital.

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.