Adrenalectomy Details


Approaches to Adrenalectomy


Open Adrenalectomy

Open adrenalectomy may be necessary if there is an underlying concern for malignancy (cancer). It is usually performed through a subcostal incision (a surgical cut made just below the ribs) on the side of the adrenal grand that is going to be removed.

Laparoscopic Approach

The laparoscopic approach is the gold standard for removal of the adrenal glands in most cases.

Advantages of laparoscopic adrenalectomy include:

  • Less pain
  • Smaller scars
  • Less hospitalization time
  • Quicker recovery

The Procedure

  • Patient will be lying on his/her side (right or left, depending on which adrenal gland is going to be removed).
  • In an average case, four small incisions will be made in the abdominal wall to introduce the laparoscopic instruments and camera.
  • The adrenal gland will be dissected away from the surrounding structures.

Risks of Adrenalectomy


In general, laparoscopic adrenalectomy has a low risk of complications. Possible complications include pain, bleeding, infection, injury to nearby structures, and the need to convert to an open procedure.

Open adrenalectomy has the same general complications as laparoscopic adrenalectomy; however, length of hospital stay is usually longer, and stronger pain medications may be required to alleviate the pain.

Besides the complications mentioned above, there are additional, specific sets of possible complications that vary according to the reason you are having the surgery. Your surgeon will discuss these with you during your preoperative appointment.

Before Adrenalectomy


Preparing for Operation

  • You will be contacted by the pre-operative call center prior to your surgery to confirm the time and date of your surgery. If you do not hear from them by the business day before your surgery, please call them at 720-848-6070 between 2 and 4 p.m.
  • Do not eat or drink anything for 6 hours before the operation.
  • Shower or bathe as usual on the morning of the operation. 

Medications

  • Do not take aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs for 7 days before the operation.
  • Stop herbal medications and supplements 2 weeks before surgery.
  • Blood thinners such as Coumadin (warfarin), Pradaxa (Dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), Lovenox (enoxaparin), Fragmin (dalteparin), and Plavix (clopidogrel) need to be stopped a few days to a week prior to surgery. It is important to discuss with your surgeon exactly when these medications should be stopped.
  • Stop ACE/ARBS medications 24 hours before surgery. These include any medication that ends with -pril or –sartan (e.g., Acupril, Losartan, Prinivil, Lisinopril)
  • Do NOT stop inhalers and other lung medications.
  • Do NOT stop beta blockers (metoprolol, atenolol, etc.)
  • Discuss diabetes medications with your doctor or Pre-Procedure Services.
  • Stop ADHD drugs one day before surgery.
  • Stop cholesterol/lipid meds one day before surgery.
  • Other medications such as antacid medications and medications for depression or anxiety are generally OK to take on day of surgery; discuss with your surgeon if you have questions.

When You Arrive

  • When you arrive at the hospital, the first step will be registration. Then you will go to the pre-operative area, where a nurse will guide you through a series of safeguards and preparations for surgery.
  • Next you will meet the surgical team, which includes anesthesia professionals, nursing staff, surgical residents, and your surgeon.
  • You will be given general anesthesia, so you will be asleep during the procedure.
  • The duration of the operation depends on the type and extent of the resection. Two to three hours is typical.
  • Your surgeon will contact your family as soon as your operation is completed.

If you have questions before your surgery, please call 303-724-2724.

After Adrenalectomy


  • You will wake up in a recovery room and will spend anywhere from an hour to several hours in the post-anesthesia care unit (PACU) before being transported to your hospital room.
  • Some patients require admission to the intensive care unit for close monitoring. Others may be admitted to a regular hospital room. Your surgeon will determine the appropriate hospital room.
  • The night after your surgery, you will be offered ice chips and sips, or in some cases, a clear liquid diet.  Please take it slow and easy with these to help prevent nausea and vomiting.
  • You will have patient-controlled analgesia (pain control) or nurse-controlled analgesia, depending on your operation.  Your nurse will advise you on this.
  • All patients undergoing surgery are at risk of developing blood clots in their legs. This is a problem that we need your help to prevent!
    • Frequent walking can lower the risk of blood clots. Starting on the day after surgery, please contact your nurse to assist you with walking outside of your room 5 times every 24-hour period after your surgery. Please notify your nurse when you are ready to walk.
    • You will also be prescribed specialized stockings and compression boots for your legs. Please wear these at least 23 hours per day.
    • You will also be prescribed a blood thinner (heparin) that is given in the form of a tiny skin shot 1-3 times daily. The frequency of shots needed depends on the type of heparin used and your risk for blood clots.
  • Typically, it is OK to shower on post-operative day #2 and daily thereafter as desired.
  • When you are first recovering from surgery, you will be hooked up to a machine to deliver fluids intravenously (“IV”). As your recovery advances, your IV fluids will be decreased and then discontinued. Your diet will be advanced as your bowels begin to function (passing gas), and your medications will be transitioned from IV to oral forms (pill, tablet, or liquid).
  • Typically, we send patients home when they are eating well, their pain is controlled, and their bowels are functioning (passing gas).  On average, patients spend 1-2 nights in the hospital after a laparoscopic adrenalectomy and 3-5 nights following an open surgery.
  • Your surgical team (surgeon, residents, nursing staff, and nursing assistants) will be watching you very closely to identify problems that may occur after surgery.  The surgical residents will come to see and examine you very early every morning. 
  • As you recover, we watch closely for signs of infection, bleeding, or other postoperative problems.  In rare cases, these problems become serious, and it is necessary to move a patient to the ICU for intensive care.  In other cases, again uncommonly, it is necessary to bring a patient back to the operating room for further treatment.  In these unusual cases, your family will be kept informed.  
  • Important: To prevent infections, please wash your hands frequently and ask your visitors to do the same.  Do not hesitate to ask any of your caregivers if they washed their hands or used alcohol rub before they are in contact with you.

Care at Home

  • Remain active and walk several times daily.  It is OK to be outside of your house.
  • Showering is OK. However, do not take a bath until you have been out of the hospital at least 10 days and your wound is completely healed.
  • If you have had a laparoscopic operation, you may begin physical activity and exercise as soon as your postoperative pain and soreness have resolved. If you have had open surgery, you will need approximately 8 weeks of recovery before you will be able to return to normal physical activity or exercise.
  • If you have an open adrenalectomy, there may be staples or sutures in place that need to be removed around 10-14 days after your surgery. 
  • Resume your regular medications at home.
  • Pain control: You will be given a prescription for a narcotic pain medication. Please use this medication only for pain that is not controlled by Tylenol and/or ibuprofen. For most patients, 400 mg (2 tablets) of ibuprofen every 8 hours should provide very good pain relief. 

Common Issues During Recovery

  • You may feel tired for several days or longer.
  • You may experience some constipation that is usually due to the pain medication. If you experience this problem, take a laxative such as Colace® or Milk of Magnesia twice a day while you are on the pain medication.

When to Contact Your Doctor

  • If you have a fever above 101 degrees.
  • If you notice redness or drainage from your incision.
  • If you have increasing abdominal pain.
  • If you experience vomiting more than once.
  • If you have pain or swelling in your legs.
  • If you have difficulty breathing.
  • If you have chest pain.
  • If you are experiencing painful urination or decrease in your urinary output.
  • If you cannot eat and drink.
  • If you have any other concerning symptoms that are not listed here.

For non-emergency issues or questions during regular business hours, please call Angela Fauth at (303) 724-2724.

For after-hours, non-emergency medical issues, you may contact the answering service at (303) 724-2728 or call the hospital operator at (720) 848-0000 and ask for the surgery resident on call.

For medical emergencies, dial 911 or go to closest emergency department.

Scar Management


Scarring is a part of every surgery and is very important to many patients for a variety of reasons: Scars may be painful, itchy or unsightly. Below is a list of common topical agents that are available over-the-counter for scarring.

Most incisions will heal to a thin, cosmetically acceptable scar without using any of the agents described below. However, if you would like to use a topical agent to improve healing and the cosmetic appearance of your scar, we recommend a silicone-based product. See below for additional details.

If you're short on time, you can skip to the summary.


Silicone

Silicones are synthetic polymers that can be a liquid, gel, or rubber.

Findings

Several studies illustrate that treatment of hypertrophic and keloid scars with silicone gel improves the appearance and bulk of the scars, especially in patients with burns. The superiority of one form of silicone gel dressing over another is not clear. Although both silicone gel sheeting and silicone gels improved scars, studies indicate no significant difference between the two forms.

Silicone dressings are believed to decrease scars via wound hydration, increased static charge, and modulation of growth factors.

Materials other than silicones (i.e., polyurethane) have shown to be equally effective in the treatment of hypertrophic scars. Both silicone and non-silicone gel dressings have been effective in reducing scar size, induration, and symptoms, but no significant differences have been noted between treatment with silicone and treatment with non-silicone gel dressings.

Bottom Line: There is good evidence showing the efficacy and safety of topical silicone for the treatment of hypertrophic and keloid scars. Silicone gel may improve the thickness, color, and texture of scars, especially thick ones. Although early treatment is ideal, silicone gel sheeting may still be beneficial for older scars.

Patients who wish to use silicone gel for scar management should apply it to the scar for 8 to 24 hours per day. It may take several months to see improvement.


Vitamin E

Vitamin E preparations are probably the most popular for use in improving the cosmetic appearance of scars.

Belief Basis

Early studies showed that vitamin E, applied topically, penetrates deep into the dermis and subcutaneous tissue, which is likely what led to the idea that vitamin E may improve wound healing when applied topically. When the skin is injured, free oxygen radicals are released in the inflammatory phase and may affect healing. In theory, Vitamin E could reduce free radicals by its antioxidant activity, thus enhancing wound healing.

Findings

Research on the effects of vitamin E on skin healing is sparse. Studies have shown that topically applied vitamin E provides no more effect than other emollient-type ointments, and hydration appears to be its only beneficial effect. Interestingly, topical vitamin E may actually cause more harm than good, possibly worsening a scar's appearance and causing contact dermatitis, contact urticaria, and erythema multiform-like reactions in some patients. A recent report from Widegrow has highlighted the skin irritation and reduced tensile strength caused by vitamin E. Use of vitamin E later on in the scar's maturity (4 to 6 weeks and later) may flatten the scar because of its hydrative capabilities, but it may result in a stretched and weakened scar because of its decreased strength effect on the scar; and if used too early, wound separation can occur.

Bottom Line: Although many patients believe vitamin E speeds wound healing and improves the look of a scar, current research evidence does not support this idea. In fact, studies report adverse effects with use of vitamin E.

We discourage patients from using topical vitamin E on healing wounds and scars.


Onion Extract

Another popular and heavily marketed over-the-counter scar treatment consists of onion extract in a topical gel, which has been marketed as a product to improve scar appearance and texture (Mederma, Merz Pharmaceuticals).

Theories

The mechanism of onion extract seems to reside in its antihistamine properties. The theory behind this is that a compound that blocks histamine release may decrease collagen production by fibro-blasts, resulting in reduced scar volume and normalization of the scar maturation process. The cosmetic result is a decrease in scar redness and hypertrophy.

Findings

Wounds treated with Mederma did show significantly better improvement of collagen organization. However, a prospective, double-blind study of Caucasian males demonstrated that the effects of topical onion extract on cosmetic appearance, erythema, and hypertrophy of scars in new surgical scars were equivalent to those of petroleum emollient.

Bottom Line: Products containing onion extract (i.e., Mederma) do not improve scar symptoms and have not shown any benefit over petroleum emollients. Applying this product to scars will probably not cause any harm, but will also probably not improve them.


Honey

Honey has been used as a dressing for wounds and burns for centuries.

Theories

Honey' effects on wound healing are theorized to be from its antibacterial activity in addition to its hydrating properties.

Findings

A review of 22 clinical trials involving more than 2,000 patients concluded that honey rapidly clears existing wound infections and protects against further infection, reduces swelling, minimizes scarring, removes infected and dead tissue, and speeds healing by stimulating new tissue growth.
Bottom Line: More well-designed, double-blind controlled trials in humans are needed, but preliminary studies are promising regarding honey and its wound-healing and scar-improvement properties.

Applying honey to a healing wound or existing scar has not been shown to be harmful and may speed healing and improve scar appearance.


What works? The bottom line

To summarize, silicone gel has the most data behind it as an efficacious topical, over-the-counter treatment option for scars, and is an option for patients who want something they can buy themselves. Also, there is probably not any harm, and possibly some benefit, to rubbing honey onto healing wounds and scars.

Further controlled studies involving human subjects are needed for topical, natural preparations for scars, so in the meantime, we recommend that patients not waste time or money on other “natural” products that claim to improve the look of scars.

Sample Products: Silicone-Based Scar Therapy

We do not endorse any particular silicone gel over another; the products below are simply examples of brands that are available over the counter at the time of this posting.

Cica-Care gel sheeting (Smith and Nephew

Epi-derm (Biodermis)

Mepiform (Molnlycke Health Care)

Kelo-cote (Alliance Pharmaceuticals)

ScarGel (Spenco)


This information is provided by the Department of Surgery at the University of Colorado School of Medicine. It is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.