Routine postoperative chest radiography is not needed after flank incisions with eleventh rib resection

We wanted to determine whether routine postoperative chest radiography is needed after surgery with eleventh rib resection.

Data on 80 patients who underwent radical or partial nephrectomy, nephroureterectomy or adrenalectomy through 82 flank incisions with eleventh rib resection were collected and analyzed retrospectively.

Radical and partial nephrectomies, nephroureterectomies and adrenalectomies were done through 47, 20, 6 and 9 flank incisions in 80 patients, respectively. Among these, one patient underwent a partial nephrectomy and subsequent contralateral radical nephrectomy, and another patient underwent simultaneous bilateral adrenalectomies. The intrapleural space was entered accidentally in 16 flank incisions (19.51%). Repair was performed with a simple evacuation technique at the time of surgery, and a chest tube was needed in only three patients (18.75%) according to postoperative chest x-ray evaluation after pleural repair. Of the remaining patients who had no evidence of pleural opening on the water seal test before wound closure, none developed respiratory distress postoperatively and no chest x-rays were ordered, except for one patient who developed subcutaneous emphysema on the day of surgery where no evidence of pneumothorax was detected.

We concluded that when pleural injury was not observed and confirmed via the water seal test, none of the patients developed respiratory distress, and this suggests that there is no need to check for its presence with chest x-ray postoperatively.