ABSTRACT
This chapter discusses the indications, preoperative preparation, procedure, an anterior transperitoneal approach and postoperative maintenance therapy used for treating bilateral adrenalectomy patients. The indications are phaeochromocytoma, adrenocortical adenoma, adrenocortical carcinoma, non-functioning incidentaloma due to the risk of malignancy, and failure of medical therapy in Cushing's disease. The patient is placed in a supine position under general anaesthetic. A transverse supraumbilical incision is made with an upward convexity, and a complete laparotomy with a thorough examination of the abdominal contents is performed. The posterior part of the peritoneum is incised just above the level of the upper pole of the right kidney, and the inferior vena cava (IVC) and right adrenal gland are exposed. The adrenal gland is separated from the kidney with the perinephric fat and fascia. Haemostasis is ensured and the wound is closed in layers. Oral hydrocortisone 30 mg per day and Fludrocortisone 0.1 mg daily are commonly prescribed postoperative maintenance therapy.
