Adrenal Gland (also known as the Suprarenal Gland) is a gland belonging to the body's endocrine system. In our body, there are two triangular-shaped glands located above the kidneys on both sides of the upper abdomen, each weighing about 5 grams. The adrenal gland's role is to secrete various hormones, including adrenaline, cortisol, aldosterone, and certain sex hormones. These hormones are essential for metabolism, immune system function, reproductive system, and maintaining the body's salt balance. They also assist the body's response to extreme physical or emotional stress. The hormones released by the adrenal gland enter the bloodstream and act on various target organs in the body.
Anatomy of the Adrenal Gland:
Sometimes, the adrenal gland's proper function may be impaired for various reasons, and it may require surgical removal. The main reasons for removing the adrenal gland are a malignant or benign tumor, a mass that cannot be characterized through needle biopsy, and overactivity of the gland due to conditions such as Cushing's syndrome (causing an excess of cortisol production), Conn's syndrome (causing an excess of aldosterone production), or pheochromocytoma (causing an excess of adrenaline production). In rare cases, both glands may need to be removed, requiring continuous cortisol supplementation after the surgery.
Pre-Surgery:
Before the surgery, a physical examination, blood tests, and various imaging tests (e.g., CT and MRI) will be performed. Towards the surgery, the patient may need to stop taking certain medications such as blood thinners (e.g., warfarin or clopidogrel). In cases of adrenal gland removal due to pheochromocytoma, strict blood pressure control is necessary before the surgery. It is essential to inform the doctor if you are regularly taking steroids. Before the surgery, blood tests, including blood type, will be taken. You should not eat or drink anything for half a day before the surgery. Fluids will be administered intravenously, along with antibiotics and, if necessary, steroids. Special stockings designed to prevent blood clots will be used.
Surgical Description:
The surgery is performed under general anesthesia. During the surgery, the adrenal gland is removed by cutting off the arterial and venous blood supply to the gland. The removed gland will be sent for examination at the pathology institute.
In some cases, a drainage tube (thin tube exiting the abdomen) may be left in the area of the adrenal gland removal to drain any fluid accumulation. The drainage tube is usually removed within 1-2 days after the surgery.
The surgery lasts several hours. After the procedure, the surgical incision is closed using stitches or staples. Following the surgery, you will be transferred to the recovery room to ensure a slow and safe awakening, and later to the surgical department for continued monitoring and care.
There are two approaches for performing the surgery - open and laparoscopic. The decision regarding the surgical approach will be made by the operating surgeon, considering various factors relevant to your case and consulting with you.
Open Approach: This approach is performed through an incision in the center of the abdomen or below the rib arch. This method was common in the past, mainly for removing large adrenal tumors. Nowadays, most surgeries are performed using the laparoscopic approach (explained below). It is essential to note that the outcomes of adrenal removal surgeries performed in our department have shown that laparoscopic removal can be performed even for large tumors (medical...)
Laparoscopic Approach: In this approach, small incisions are made in the abdomen, and tubes are inserted through them. The abdomen is inflated with gas. Through the tubes, a small video camera is inserted, allowing the surgeon to view the surgery on a screen. The surgical instruments are also inserted through these tubes, so the surgery is performed inside the abdomen without the need to open the abdomen. The adrenal gland is removed through an incision about 4 cm long in the upper abdomen on the side of the surgery. However, in specific cases, there may be a need to switch to open surgery.
Research has shown that laparoscopic removal has clear advantages, such as smaller incisions, less post-operative pain, shorter recovery time, and better cosmetic results.
Complications:
As with any surgical procedure, various complications may arise, including excess bleeding, infection in the wound, urinary or bowel complications, blood clots, damage to adjacent organs during the surgery, incisional hernia formation, and complications related to anesthesia.
Factors that may increase the risk of complications include advanced age, obesity, smoking, poor nutrition, and chronic diseases (e.g., heart disease, diabetes, lung disease).
Post-Surgery Treatment:
After the surgery, monitoring will be conducted in the recovery room, followed by continued hospitalization in the surgical department.
The average hospitalization after the surgery is 2-3 days.
Despite reduced discomfort, post-operative pain is expected. Pain relief medication will be provided as needed and in consultation with the pain service.
After the surgery, gradually resume activity. Walking accelerates the healing process and reduces the risk of complications such as lung inflammation or blood clots.
The recovery period will last about two weeks, during which the family doctor will monitor the blood steroid levels and adjust oral treatment as needed.
You should weigh yourself daily. Weight gain may be due to fluid accumulation, and it is essential to report it to your doctor. Additionally, blood pressure should be monitored, and, of course, follow the doctor's instructions regarding the healing period and post-operative follow-up.
After your discharge from the hospital, if any of the following symptoms appear, contact your doctor:
- High fever above 38.5 degrees Celsius or chills.
- Redness, swelling, increasing pain, excessive drainage, or secretion from the incision site.
- Nausea or vomiting.
- Uncontrolled pain.
- Pain, burning, urgency, or frequency during urination, persistent urinary leakage.
- Cough, shortness of breath, or chest pain.
- Pain or swelling in the hands or feet or legs.
- Headaches or dizziness.