Body image alteration after flank incision: relationship between the results of objective evaluation using...

We evaluated subjective and objective alterations in body image and configuration of patients who underwent urological surgery via a flank incision.

Eligible for study were 17 patients who underwent urological surgery via an 11th rib transcostal incision. Preoperative and postoperative abdominal computerized tomography were used for evaluation. The intra-abdominal contents surrounded by the vertebral bones and muscles forming the body trunk were divided into 4 subspaces. The areas of these 4 portions were measured and the calculated ratio of the contents of each portion determined preoperatively was compared with that determined postoperatively. Of the 17 patients 15 answered a questionnaire on the perception and bother of body image alteration. We compared their subjective answers with objective results using computerized tomography.

The ratio of the ipsilateral-dorsal portion significantly increased postoperatively from 18.7% to 21.9% at the L2 level (p <0.001), 19.7% to 23.1% at the L3 level (p = 0.002) and 18.3% to 21.2% at the L4 level (p = 0.003). Posterolateral bulging was typically observed at the L2 level. Of the 15 patients who answered the questionnaire 9 (60%) perceived and 4 (27%) were bothered by body image alteration to at least a moderate extent. The ratio of increase in the ipsilateral-dorsal portion was significantly higher in the 9 patients who perceived at least moderate body image alteration than in the remaining 6 (2.2% versus 4.6%, p = 0.031).

The intra-abdominal contents deviated in the ipsilateral-dorsal direction with the patient supine after flank incision done via the 11th rib transcostal approach. This change, typically represented by posterolateral bulging, results in an altered patient body image.