University:
Swansea University
Course:
PM-139 | Human Physiology 1
Academic year:

2023
Views:

206

Pages:

4
Author:

Amal J.

ADRENALECTOMY Def: surgical removal of the suprarenal (adrenal) gland is called adrenalectomy. Indication: - hypercorticism - tumors of the adrenal medulla - ganglioneuroma - pheochromocytoma - neuroblastoma - disseminated carcinoma of breast and prostate not responding radiotherapy - adrenocortical hormone replacement therapy It is essential that all patients who are to be subjected to adrenalectomy are supported intra and post operatively by adrenocortical hormone replacement therapy irrespective to extent of the adrenal resection. Operation: Incision: Posterolateral incision through loin, or transverse, anterior (or) oblique upper abdominal thoracoabdominal incision such as used in nephrectomy. Posterior approach - posterolateral incision through loin after subperiosteal resection of 12th rib lower border of the pleura is defined and protected. ↓ Incision is extended through the bed of the 12th rib to reveal the perinephric fat within which the adrenal gland is identified. On the right side the suprarenal vein is short and may be from the vena cava if it is not identified & ligated at an early stage of the dissection. By finger and gauze dissection keeping close to the gland, the gland is freed from below and behind upwards tigating and dividing bleeding vessels as they are encountered until it is suspended by it own vascular pedicle near its apex. Anterior approach - through a curved transverse incision or long midline incision. The left gland is approached 1st by entering along the lateral leaf of the lienoveral ligament and then curving downwards & medially so as to enable a vide peritoneal flap to be reflected by retracting the spleen downwards & medially the adrenal gland comes into view the fascia over its lateral border, and by gauze dissection the blood vessels of the gland are defined ligated & divided thus freeing the gland which is removed. After removal each gland should be inspected to check its completeness & each adrenal bed must be searched for the presence of accessory adrenal tissue (present in 31% of cases). If this important step is omitted, failure of the operation is not unlikely.