Hypertension Crisis in Adrenal Surgery and Treatment of Postoperative Hypotension

Abstract

the aim of the study was to present our experience in the treatment of pheochromocytoma, which can have untypical manifestations or their complete lack. Surgery still is the main treatment. Since introducing minimally invasive method the operative choice between open and videoscopic still remains. The proper diagnosis, preparation and surgical treatment allow to avoid serious cardiovascular complications. In the treatment, pre-or intraoperative hypertensive crisis and hypotension appearing after removing the tumor are the important issues. Based on our study from 29.10.1997 to 31.01.2009 authors are showing methods and principles of preparation and the intra-and post-operative complications associated with performed operation. Additionally the problem of pheochromocytomas, clinically asymptomatic, so-called silent pheochromocytoma is discussed. Evaluated material consisted of 125 patients with pheochromocytoma. 32 (25,6%) were operated by open, classical method, and 93 (74.4%) laparoscopically via lateral transperitoneal approach. Conclusions. 1. The course and the result of surgical treatment of pheochromocytomas depend on proper diagnosis and preoperative preparation. 2. Laparoscopic adrenalectomy through lateral transperitoneal approach should be acknowledge as the referential operation in the treatment of pheochromocytoma. 3. Clinically asymptomatic pheochromocytoma require routine preparation similarly to other forms of pheochromocytoma.