What should I do before surgery?
Preoperative Clinic Visit will include:
- A History and Physical Examination:
It is important to know your full health history and any and all of the medicines you take. Depending on your other medical problems, you may need to be seen by another specialist before your operation.
- Blood work and Tests: According to your age, medical condition, and the type of surgery planned, you may be asked to have an EKG (heart tracing), chest x-ray, or blood work before your surgery.
- Instructions for you and your family: We will explain what to expect on the day of surgery and answer any questions that you may have. We will also give you written information with maps and phone numbers. A doctor will explain the surgery and you will be asked to sign a Consent to Surgery form.
- Anesthesia Evaluation: The anesthesiologist will see you on the morning of surgery if you are generally in good health. If you have any serious medical conditions, we will send you to our preoperative anesthesia clinic. Your record is then reviewed and the type of anesthesia is planned in advance.
Most patients are admitted to the hospital the day of the operation. You are usually required to have no food or drink at least 6 hours prior to surgery. This reduces the chances of you vomiting recently eaten food when you are being put to sleep, an event which could lead to life-threatening lung infections.
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What can I expect after the operation?
How long does surgery last ?
The duration of the actual surgical procedure varies between one and four hours, depending on the size of the gland(s), operative approach, and extent of the operation.
How long will I be in the hospital ?
Your hospital stay will depend on the method and extent of your surgery. If you need an open operation, you may be in the hospital for 4-8 days. If you undergo a laparascopic adrenalectomy, you will likely be able to go home in 1-2 days.
After your operation
- You will have a call light handy - let the nurse know if you need something
- It is normal to feel tired, groggy and weak from the effects of anesthesia. Do not get out of bed by yourself. Ask for help.
- When you are steady, you will be encouraged to sit and walk frequently. Time out of bed aids your recovery.
- You will have pain medicine available to relieve your discomfort. This is usually given intravenously or orally depending on the operation and the level of discomfort.
- You will receive ice chips to start and then be given a clear liquid diet such as Jello or tea. You will progress onto regular food. The speed of this progression depends mostly on the method of adrenalectomy.
- You may shower as usual after about 24-36 hours. The incision(s) may be gently washed, not scrubbed, with mild soap and water. Pat the area dry.
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What complications can occur ?
- Adrenalectomy is a safe and effective procedure. However, as with all major abdominal procedures complications can occur during or after surgery. Potential complications during surgery are related to bleeding and damage to surrounding structures such as small and large intestines, kidney, liver, spleen, pancreas and blood vessels. When identified these injuries can be repaired during surgery. Some of these complications can also occur after surgery and may require admission to the hospital or another operation. In addition, infection in the incision or in the abdomen may require additional procedures. Laparoscopic adrenalectomy is associated with low complication rates at UT Southwestern Medical Center.
- Please inform your surgeon if you have previously had any of the following problems or believe you may be prone to them. General risks of undergoing an operation include:
- Heart and circulation problems such as heart attack or blood clot formation. Clots which form in the legs can move to the lungs and cause life-threatening problems. Blood clots or debris can similarly cause a stroke.
- Abnormally high or low blood pressure is a risk following removal of certain adrenal tumors and can usually be prevented or treated with medicine.
- Other infections such as bronchitis, pneumonia, or urinary infections can develop after a general anesthetic and operation.
- Depending on the type of adrenal disorder leading to your adrenalectomy, you may require oral steroid medication to replace those steroids formally made by the adrenal gland. In some cases, these steroids are essential for life.
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What signs indicate potential complications ?
There are not always warning signs of complications, however some signs may indicate that you have developed complications. These include:
- Fever (high temperature)
- Rapid breathing or rapid heart rate
- Abdominal pain that increases in intensity or duration after the first few days after surgery.
- Fainting or persistent vomiting may also suggest complications.
You should seek medical attention after the appearance of these symptoms or signs.
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What will I need to know to go home?
- A nurse will review discharge instructions with you and give you written information to take home.
- You will be scheduled to see your surgeon in 1-3 weeks after your operation.
- When you leave, your wound will be covered by paper "Steri-Strips" which will remain in place until your post-operative clinic visit. If they become unsightly or bothersome to you, you may remove them 10 days after your operation.
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How long does it take my incision to heal?
- Your incision(s) will be watertight in about 24-36 hours allowing you to shower carefully. The incision normally heals fully within a few weeks. There is also swelling and a feeling of firmness under the incision that may last for a couple of months. If you have surgical staples closing your wound, these will be removed by 14 days after your operation.
- Most scars are most noticeable 1-2 months after the operation and gradually become less so after several months. Until that time, you may notice the color is more red than surrounding skin. This is normal and will improve.
- Depending on the method of your adrenalectomy, your incision will also involve a variable amount of muscle. This also takes a few weeks to heal and should not be strained. Your surgeon will give you specific recommendations about activity and weight lifting limits.
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How should I alter my diet after adrenal surgery ?
There are no general dietary restrictions for patients who have had adrenal surgery, however your surgeon may ask you to refrain from high salt diets or avoid certain medications if you are prone to high blood pressure.
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When can I go back to work ?
Convalescence after adrenalectomy is variable and depends on your prior health status, the extent of your operation and the operative approach. Most patients return to active work schedule within 5 days after laparoscopic adrenalectomy or 2-3 weeks after open adrenalectomy. Your surgeon may require that you return to light work schedule after adrenalectomy.
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What are the long term consequences of removing the adrenal gland(s) ?
Since most people have two functioning adrenal glands, the removal of one adrenal gland does not usually require long term hormone supplementation, although if the hyperactive adrenal gland suppresses the function of the other adrenal gland, it may require several months for the remaining adrenal gland to regain function. This means that you may require hormone (usually steroids) pills during that period. After removal of both adrenal glands you will require life-long steroid replacement to prevent complications of steroid insufficiency.
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