title: Previously unreported high-grade complications of adrenalectomy.
abstract: BACKGROUND
  Serious complications of adrenalectomy are rare but the incidence may be underestimated if they occur outside major referral centers. We report five cases of high-grade complications after adrenalectomy that have not been previously described.
  
  
  METHODS
  The records of five cases of adrenalectomy performed at outside hospitals were reviewed. Four cases were referred for management of complications and one for medical-legal review. The nature of the adrenal lesion, operative approach, complication(s), and subsequent clinical course and complication management were assessed. Both open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) cases were included.
  
  
  RESULTS
  Operative indications were pheochromocytoma (N = 3), aldosteronoma (N = 1), and a nonfunctioning 6-cm hypervascular mass (N = 1). Complications of adrenalectomy included: case 1--complete transection of the porta hepatitis during right LA resulting in hepatic failure requiring emergent liver transplantation; case 2--ligation of the hepatic artery during right OA resulting in recurrent cholangitis and bile duct sclerosis requiring liver transplantation; case 3--ligation of the left ureter during LA resulting in postoperative hydronephrosis and loss of renal function; case 4--loss of left kidney function after OA, likely secondary to renal artery ligation ultimately requiring laparoscopic nephrectomy; case 5--LA of a normal adrenal gland for a 6-cm hypervascular mass thought to be arising from the adrenal gland. Three-month postoperative imaging demonstrated a persistent mass and the patient underwent hand-assisted laparoscopic nephrectomy for a left upper pole renal cell carcinoma that was missed at the time of LA.
  
  
  CONCLUSIONS
  Despite the generally low morbidity of adrenalectomy, serious and potentially life-threatening complications can occur. Surgeon inexperience may be a factor in the occurrence of some of these complications which have not been previously described.
authors.affiliation: Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA.
authors.forename: Deron J
authors.initials: DJ
authors.lastname: Tessier
authors.forename: Rafael
authors.initials: R
authors.lastname: Iglesias
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
authors.forename: Kent
authors.initials: K
authors.lastname: Kercher
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
authors.forename: D Lee
authors.initials: DL
authors.lastname: Gorden
authors.forename: L Michael
authors.initials: LM
authors.lastname: Brunt
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects*; D000328:Adult; D003951:Diagnostic Errors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000473:pathology / Q000601:surgery*