Adrenalectomy is a surgical procedure that removes the adrenal gland (adrenal gland). The operation is carried out both on the one hand and on the other. Accordingly, one or two organs can be removed. Basically, the adrenal gland is removed due to the presence of a tumor in its structure.
If the tumor belongs to benign formations or does not show activity, a partial adrenalectomy is performed – only the tumor itself is removed, and not the entire adrenal gland, as in the case of total adrenalectomy.
After the intervention of surgeons, a part of the removed organ must be sent for histological examination in order to establish the morphology of the neoplasm and the cause of its occurrence. Incomplete removal of an organ is indicated in situations where there is a chance to preserve the organ.
Indeed, in the case of total removal of both adrenal glands, the patient will be forced to take hormonal drugs for life.
Briefly about physiology
The adrenal gland is a paired endocrine gland located in the region of the upper poles of the kidneys, slightly outward from the lower thoracic or upper lumbar vertebrae. The weight of one gland is only four grams.
According to the structure of the glands, two layers are distinguished – outer (cortical) and inner (cerebral). They come from certain types of embryonic structures, in this regard, they synthesize substances of different types.
The cortical layer synthesizes corticosteroids and sex hormones, and in the inner layer – hormones of the catecholamine series and a number of peptides.
Due to the release of hormones, activation or inhibition of many processes in the body is observed, immunity, the state of the nervous and endocrine systems, blood pressure, etc. are regulated.
Indications and contraindications to surgical intervention
This operation is carried out in strict accordance with indications. Because there is always a risk to the patient’s health.
The indications for surgery include:
- Cortical malignant tumor.
- Cushing’s Syndrome.
- Hormone-active tumors of the type of pheochromocytoma, aldosteroma, adenoma.
- A significant increase in the size of the organ.
- Dysfunction of the adrenal glands with an unexplained cause.
Contraindications to the operation include:
- The patient’s coma.
- Decompensation of heart activity.
- Septic contamination.
- The presence of diffuse purulent inflammation of the peritoneum.
- Decreased activity of the blood coagulation system.
- Late pregnancy.
- Adhesive disease.
- Infectious processes in the abdominal wall (front).
Comparing all the pros and cons regarding the operation, the doctor and the patient or his relatives decide on the rationality of the operation.
Diagnosis of diseases
The most common method for diagnosing adrenal diseases is ultrasound. Less commonly, computed tomography or magnetic resonance imaging is used.
To identify the hormonal activity of the neoplasm, urine tests of the patient for the level of adrenal hormones are used. It is possible to conduct an organ biopsy with subsequent morphological examination of the material obtained.
Preparing for an operation
The day before the surgery, the patient is prohibited from eating. The reason for this is the presence of a high probability of suffocation of the patient with his own vomit during the implementation of anesthetic accompaniment.
Before the very beginning of the operation, the patient is injected with special drugs in order to improve the effect of anesthesia. For this purpose, in the operating room, an ulnar venous catheter is installed in the patient, through which drugs will be injected, both before and after the operation.
A mixture of special gases is supplied to the patient through a breathing mask. Then the trachea is intubated. Only after carrying out the listed manipulations can you start the operation.
The course and conduct of the operation
The possibilities of medicine are such that today two types of adrenalectomy are used – cavity (traditional) and endoscopic (inside the abdominal cavity).
According to the scheme of abdominal surgery, access is carried out using an incision on the patient’s body. Then the doctor goes into the abdominal or chest cavity to provide access to the affected organ. After that, an operative reception is performed (in this case, removal of an organ) and layer-by-layer stitching of tissues.
After the operation, a 20-30 cm scar remains on the body. A similar method of treatment is used in the presence of large neoplasms (from ten centimeters or more).
More suitable from the cosmetic point of view is the method of laparoscopic adrenalectomy. Therefore, it is the most widely used. The only drawback of this method is that the duration of the operation increases (twenty minutes more than with traditional surgical treatment).
On the anterior abdominal wall of the patient, four incisions are made about one and a half centimeters in diameter. During the operation, a special endovideoscopic technique is used. The affected organ is removed through one of the incisions in the abdomen and the tissues are sutured in layers. This method removes tumors up to 1 centimeter in size.
In the event that it is impossible to complete the endoscopic operation, they switch to the classical method.
Recovery and rehabilitation
Open surgery is always stressful for the human body. During the first hours after the end of the operation, the anesthesia ceases to work, and the patient may feel severe pain. To eliminate the pain syndrome, the patient is given strong analgesics.
During the entire postoperative period, the drains installed in the body cavity are carefully monitored.
After the surgical method of treatment, it is strictly contraindicated to eat and drink during the first hours after the treatment. All necessary nutrients are introduced into the body parenterally. At the same time, the state of the gastrointestinal tract is carefully monitored.
Postoperative sutures are processed daily.
If the operation was performed using the laparoscopic method, the patient is assigned to bed rest for a period of one day, if laparotomy, this period is significantly lengthened.
If external wounds were sutured with absorbable material, they are not removed, and if they were sutured with non-absorbable material, they are removed after five to seven days.
When both adrenal glands are removed, the doctor prescribes lifelong hormone therapy.
Forecast and consequences
With timely detection and treatment of the disease, the prognosis is positive both for health and for working capacity.
The operation itself does not have serious consequences. If both adrenal glands are removed, the patient will be prescribed adequate hormonal replacement therapy.
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