How is adrenal surgery performed?
What are the potential complications?
Overall, complications rates are significantly higher in open surgery compared to laparoscopic procedures. In open surgery, lung problems are the most common complications occurring in approximately 6% of patients. These include pneumonia and atelectasis (collapse of the spaces in the lungs that transfer oxygen to the blood). Wound infection occurs in approximately 3%. The risk of wound infection and/or problems with healing is higher in patients with Cushing's SyndromeCushing's syndrome - a disease where too much cortisol is being made. Post-operative bleeding is a rare potential complication of surgery. The risk of requiring a blood transfusion is higher with open than laparoscopic surgery. Any surgery in the abdomen may result in an ileus (a condition in which the intestines "are asleep" and do not work normally for a period of time) which will get better in a few days to a few weeks. Any operation in the abdomen will cause adhesions (i.e. scar tissue) to form and may cause an intestinal blockage in the future. This blockage may occur shortly after surgery or many years down the road. Finally, adrenalectomyAdrenalectomy - an operation to remove the adrenal gland as with other surgeries may result in blood clots forming in the veins of the legs which may break off and travel to the lungs. A number of things can be done to reduce this risk including injections of a mild blood thinner (most commonly heparin) and wearing stockings that periodically squeeze the legs. The risk of these blood clots is higher in patients with tumors that produce an excess of cortisolCortisol - a glucocorticoid that controls glucose production and suppresses the immune system and those with cancer.
Adrenal insufficiency is a life-threatening problem where the body is not making enough cortisol. This complication can happen in patients with Cushing's Syndrome where the other adrenal gland is not making enough cortisol because it has been suppressed by the tumor or in patients who have had bilateral adrenalectomy (i.e. both adrenal glands removed) who are not on enough steroids post-operatively. Symptoms of this condition include feeling generally unwell, nausea, vomiting and confusion. Patients in this situation may need steroid medication for up to one year following surgery and for those who have had both adrenals removed, will require lifelong steroids.
Injury to surrounding organs
Rarely, the blood vessels or organs near the adrenal gland may be damaged. On the left side, the spleen is the most commonly damaged organ and happens in only 1.5% of patients, but it may require removal of the spleen. If the spleen is removed patients should be vaccinated following surgery. The tail of the pancreas and the blood vessels supplying the kidney are also at risk of damage during left sided surgery. Damage to the blood vessels supplying the kidney may result in hypertension (high blood pressure). On the right side, the liver and duodenum (first part of the small intestine) are also at risk of injury.