Dr. Harika Tirungari

What is an Endocrine Surgery?

It is a surgery of one or more endocrine glands. Endocrine glands are glands which secrete hormones and control function of almost all the cells in the body. It is a surgical subspecialty. It includes surgery of endocrine glands, such as the thyroid gland, the parathyroid gland, the adrenal gland, glands of the endocrine pancreas, and some neuroendocrine glands.

Which are the Clinical Conditions that require Endocrinal Surgeries?

The conditions which require endocrinal surgery are as follows:

1. Thyroid disorders: Underactive thyroid (hypothyroidism), overactive thyroid (hyperthyroidism), thyroid nodules, goiter, thyroid cancer, and thyroid cyst
2. Parathyroid disorders: Primary hyperparathyroidism
3. Adrenal gland disorders: Conn syndrome, pheochromocytoma, adrenocortical cancer, or Cushing's syndrome
4. Diseases of pancreas: Insulinomas, gastrinomas, or type 1 diabetes
5. Diseases of the pineal gland
6. Disorders of the pituitary gland

Which surgeries are included in it?

Surgeries can be minimally invasive, such as laparoscopic surgeries or open surgeries. It includes following surgeries:

1. Surgical removal of the thyroid gland (thyroidectomy) either as a part of the gland (lobectomy or hemithyroidectomy) or the whole gland (total thyroidectomy)
2. Surgical removal of the parathyroid gland (parathyroidectomy)
3. Surgical removal of the adrenal gland (either laparoscopic removal or open surgery)
4. Adrenalectomy (i.e., surgical removal of the adrenal gland)
5. Pancreatic surgery (simple tumor enucleation to larger resections)
6. Surgical removal of the pineal gland (pinealectomy)
7. Surgical removal of the pituitary gland (hypophysectomy or transsphenoidal surgery)

What Care needs to be Taken Preoperatively?

Following tests need to be done prior to the surgeries:

• Complete blood count
• Kidney profile
• Serum electrolytes
• Blood group
• Blood sugar
• ECG (for the patients who are 40 years and older)
• Chest X-ray (for the patients who are 60 years and older)All the tests need to be done 24 hours before the surgery.

After completing the tests, the doctor will evaluate the reports and will advise undergoing surgery accordingly.

Which medication needs to be adjusted?

Medications which need to be adjusted before the surgery are as follows:

1. Aspirin, ibuprofen, and vitamin E should be stopped one week prior to surgery unless otherwise directed by the doctor.
2. Dosages of coumadin, steroids, and/or insulin need to be adjusted or substituted by another medication before surgery.

What are the complications of surgery?

Following are the most common complications:

1. Infection due improper aseptic precautions
2. Bleeding from the surgical wound
3. Change in a patient’s voice and swallowing difficulty
4. Low thyroid function
5. Hypoparathyroidism (low blood levels of calcium caused by the removal of the parathyroid)
6. Formation of seroma (swelling caused by a collection of fluid beneath the incision site)

What is gallstone surgery?

It is a surgical removal of the gallstone from the gallbladder. It is also known as cholelithotomy.

What are the Statistics of the surgery?
Approximately 90% of patients who seek treatment undergo a surgery to remove the stones and the gallbladder.

What is the role of gallstone surgery?
Gallstones which are asymptomatic generally don’t need surgical removal. Treatment depends on the size and location of the gallstones. Surgery to remove the entire gallbladder with all its stones is usually the best treatment, and it is done in patients who can tolerate the procedure.

What are the indications for gallstone surgery?
Indications for gallstone surgery are as follows:

• Stone lodged in the pancreatic duct
• If the stone is causing severe pain, vomiting
• Chronically obliterated cystic duct due to gallstone
• Nonfunctioning gallbladder due to obstruction
• Calculi greater than 3 cm in diameter
• Acute infection of gallbladder (acute cholecystitis) due to gallbladder obstruction
• Chronic infection of gallbladder due to gallbladder obstruction

How is the surgery performed?
The following surgeries are done in patients who are found to have cholelithiasis and choledocholithiasis:

1. Extracorporeal shock wave lithotripsy: A special machine which generates sound waves is used to break the stone. It is only done in the people who are having a small, and soft stone. This procedure doesn’t require any anesthesia, and repeated shock wave therapy is required for complete removal.
2. Laparoscopic cholecystectomy: It is a procedure where a laparoscope (a small, thin tube) is put inside the body through a tiny incision made just below the umbilicus, and another probe is inserted to remove the stone.
3. Open gallbladder surgery: It is done to remove the gallbladder when it is infected, or inflamed, or has large gallstones, or when complications are found during laparoscopic surgery.
4. Percutaneous cholecystostomy guided by computed tomography (CT), or ultrasonography (USG) to remove the gallbladder.
   • Contact dissolution of gallstone can be done where direct catheter of a chemical solvent is introduced by the percutaneous way. It is best for cholesterol stone and, is best at removing any size of the stone.
   • Endoscopic retrograde cholangiopancreatoscopy (ERCP) is used to remove the stones which are in bile duct through the mouth, throat, esophagus, stomach, duodenum, and biliary system without any surgical incisions.

What are the complications of surgery?
Following are the most common complications of surgery:

• Bile leakage leading to biliary peritonitis
• Infection of gallbladder due to improper aseptic precautions
• Abscess formation around the gallbladder, or over adjacent structures
• Death due to rapidly spreading peritonitis causing septicemia
• Raised liver enzymes, jaundice, and severe pain

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