Perioperative complications of adrenalectomy - 12 years of experience from a single center/teaching hospital and literature review.

INTRODUCTION: The perioperative complication rate of adrenalectomy varies between 1.7% and 30.7% in the medical literature. This study presents outcomes of adrenalectomy in our center and tries to point out risk factors for perioperative problems.

MATERIAL AND METHODS: We retrospectively analyzed all patients who underwent adrenalectomy in our department from January 2004 to June 2015. Patient's sex, indication for procedure, tumor laterality, surgical approach and surgeon's case volume were taken into consideration as possible risk factors for complications.

RESULTS: There were 177 adrenalectomies performed on 170 patients. We reported 18 (10.2%) perioperative complications, 12 (6.8%) surgical and 6 (3.4%) medical. Laparotomy was a significant risk factor for medical ( p < 0.01) and overall problems ( p = 0.02). Operations more expansive than just adrenalectomy were associated with higher risk of medical complications ( p = 0.01). Procedures performed by surgeons with higher volume were associated with smaller risk of medical complications ( p < 0.01). Right and left adrenalectomies seem to be related to different kinds of risk - bleeding on the right, injury of surrounding structures on the left ( p = 0.05). Patient's sex, indication for procedure, bilateral procedure and side of operation were not statistically significant risk factors for complications.

CONCLUSIONS: Adrenal glands are surrounded by various anatomic structures (colon, pancreas, spleen, diaphragm) that may be injured during adrenalectomy. Complications following a laparoscopic procedure may arise from the use of monopolar coagulation and the patient's position on the operating table. High insufflation pressure during retroperitoneoscopic procedures may cause subcutaneous emphysema.