Adrenalectomy: instructions before and after surgery

General and important instructions before surgery

Before surgery:

- When you are admitted to the hospital, bring all the tests performed for the surgery.
- You must fast for at least 8 hours before surgery, including water.
- There is no need to shave the hair on the abdomen and pubic area (trichotomy) at home. If indicated, this will be done at the hospital shortly before surgery.
- Allergies to medications, latex, foods and other substances must be reported to the medical and nursing team at the time of admission.
- Antihypertensive medications (blood pressure pills) should be taken even on the day of surgery, with the minimum amount of water needed to swallow them.
- Some medications must be stopped before surgery:
- Oral hypoglycemic agents (diabetes pills) should be stopped the day before surgery.
- Antiplatelet agents such as acetylsalicylic acid (AAS®, Somalgin®, etc.) and clopidogrel (Plavix®, etc.) must be stopped at least 7 days before surgery if the patient takes only one of these medications. If both medications are used, they must be stopped 10 days before the surgical procedure.
- Patients taking anticoagulants such as warfarin (Marevan®) or rivaroxaban (Xarelto®) must stop the medication 5 and 3 days before, respectively. During this period, some patients will need to use enoxaparin sodium or unfractionated heparin until the day before surgery.

Right after surgery:

- Once the patient is back in the room after surgery and fully awake, he or she may eat the diet prescribed by the medical team. Food should be introduced according to the patient’s tolerance.
- On the morning after the procedure, after breakfast, it is already possible to get out of bed to shower and take short walks in the room and ward corridors. It is recommended to ask a family member or a member of the nursing team for assistance.
- After the procedure, all patients have a urinary catheter (Foley) in the bladder and an abdominal drain. During the hospital stay, the medical and nursing team will care for these devices and teach patients and family members how to handle them at home.
- The urinary catheter is usually removed on the morning after the procedure, and the abdominal drain before hospital discharge, depending on its daily output.
- The hospital stay usually ranges from 1 to 3 days, depending on the type of approach (open vs. laparoscopic or robotic) and on each specific case.
- After surgery, it is normal to have more intestinal gas, and the bowel can take up to 3 days to return to normal function. Laxatives, antispasmodics and anti-gas medications will be given as needed.

After hospital discharge:

Diet:

- There are no specific dietary restrictions; the patient should eat a healthy diet. During the first week, it is advisable to avoid foods that are harder to digest, such as fried foods, foods high in fat or heavily seasoned, and sweets, as they cause intestinal gas to build up.
- Fluids (water, tea and natural juices) can be consumed freely.
- Alcoholic beverages such as beer, wine and spirits may be consumed in modest amounts about 15 days after the procedure, if the patient has no contraindication.

Incision care:

​- Dressings protecting the incision should be changed daily, preferably after showering. If discharge from the wound heavily soils the dressing, it can be changed more than once a day. The dressing can get wet; after showering, it should be removed carefully and the wound then cleaned with saline, dried, and covered with gauze or directly with Micropore tape.
- Stitches usually do not need to be removed, because we use absorbable sutures.
- If the skin around the incision is very irritated by the adhesive tape, hypoallergenic tape can be used, or the incision can even be left uncovered.

Abdominal drain care:

- In some situations, the patient may be discharged with the abdominal drain in place. The abdominal drain (Blake drain) is a closed vacuum system that drains secretions from the surgical site. Its collector should be emptied 3 times a day or whenever it is full and has lost its vacuum. The amount discarded, the date and the time should be recorded for later review by the medical team. In general, the drain is removed when its output is less than 100 ml over 24 hours.

Physical activity:

- During the first 2 weeks after surgery, the patient should maintain relative rest, avoiding strenuous work activities, lifting weights (including small children and pets) and any kind of intense physical exercise. However, during this period it is important for the patient to move around carefully, and gentle daily walks are allowed.
- After 2 weeks, the patient may do light activities such as somewhat longer walks. Work activities that do not require physical effort can be resumed if the patient wishes. More strenuous activities, such as driving, running, sit-ups, tennis and soccer, horseback riding, cycling or workouts involving greater muscular effort, will be cleared case by case after assessment by the medical team, but in general they are not allowed before 6 weeks after the procedure.
- The patient is generally cleared to drive after the third postoperative week.
- After discharge, the patient may go up and down stairs, as long as this is done carefully.

Medications:

- At discharge, you will receive instructions about the medications you will take at home. In general, pain relievers for mild pain are prescribed and, when needed, anti-gas medications and laxatives. Antibiotics are used only prophylactically before surgery and are not prescribed for home use, except in selected cases where the medical team deems it necessary.
- Venous thromboembolism will be prevented by encouraging early walking, using intermittent pneumatic compression devices, compression stockings and, when indicated, medications such as enoxaparin sodium or unfractionated heparin given by subcutaneous injection, according to your risk of developing VTE.

Important:

In case of severe pain that does not improve with the prescribed pain relievers, significant bleeding through the catheter or drain, fever, thick yellowish discharge (pus), shortness of breath with pain when breathing, feeling unwell with a drop in blood pressure, or any other complication or concern, go directly to the emergency department of the hospital where you had surgery.

- Note: This information serves as general guidance for patients. It does not replace the in-person guidance given by the attending physician, which must be individualized according to the characteristics of the patient, the disease and the planned operation.