Complications of Adrenal Surgery
There has been a significant improvement in the understanding of adrenal disease over last ten decades, with better understanding of the physiology and biochemistry and imaging. Similarly, with the introduction of laparoscopy in the 1990s, adrenalectomy m
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Rajeev Parameswaran
There has been a significant improvement in the understanding of adrenal disease over last ten decades, with better understanding of the physiology and biochemistry and imaging. Similarly, with the introduction of laparoscopy in the 1990s, adrenalectomy moved from a morbid open procedure to a less invasive and less morbid procedure. Despite the advances, complications do arise, and some are related to the disease process and others to the surgical approaches. These complications may be avoided by adequate vigilance and preparation and may be divided into preoperative, intraoperative and postoperative complications, which are addressed in this chapter.
Introduction Adrenalectomy is performed for patients with tumours or disorders arising in the adrenal cortex or medulla and may present in three ways: (a) those associated with hyperfunctioning adrenal lesions, (b) those associated with malignancy and (c) those with uncertain significance and picked up incidentally. Where presenting with hormonal oversecretion, the symptoms are related to the excess of cortisol, mineralocorticoids, androgens and catecholamines or their
metabolites. Adrenal malignancies may present with symptoms of hormone excess or pressure effects of the tumour especially when large. Secondary hypertension is a common feature seen in functioning adrenal neoplasms, along with metabolic problems such as hyperglycaemia, hypokalaemia and metabolic alkalosis. The various causes of adrenal masses are shown in Table 33.1. Complication is defined as a condition or event leading to unfavourable patient health by causing irreversible damage and deviation in the normal postoperative course and resulting in prolonged hospital stay. Complications sustained following surgery may be classified based on the severity of injury as proposed by Dindo and Clavien [1] and is shown in Table 33.2. However, in this chapter complications will be classified as preoperative, intraoperative and postoperative. One of the key measures to prevent complications is to ensure that patients are selected appropriately for surgery. It is important that certain principles are followed to ascertain that both short-term and long-term outcomes are significantly better. The choice of type of surgery and indications depend on few factors, namely, tumour size, tumour function and imaging characteristics.
R. Parameswaran Division of Endocrine Surgery, National University Hospital Singapore, Singapore, Singapore e-mail: [email protected] © Springer Science+Business Media Singapore 2018 R. Parameswaran, A. Agarwal (eds.), Evidence-Based Endocrine Surgery, https://doi.org/10.1007/978-981-10-1124-5_33
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432 Table 33.1 Causes of adrenal masses Due to hormone excess Cushing’s adenoma Aldosteronoma Pheochromocytoma Congenital adrenal hyperplasia Macronodular adrenal disease
Non-hormonal causes Adenoma Angiomyolipoma Neuroblastoma Ganglioneuroma Carcinoma Cyst Metastasis
Uncommon causes Haemangioma Haemorrhage Amyloidosis Tuberculosis
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