title: Short and long-term morbidity of thoracoabdominal incision for nephrectomy: a comparison with the flank approach.
abstract: OBJECTIVE
  A thoracoabdominal incision provides optimal exposure for radical nephrectomy, especially for large tumors. Intuitively it is perceived that the morbidity of a thoracoabdominal incision far exceeds that of a flank incision. We compare the morbidity of thoracoabdominal and flank incisions, which to our knowledge has not been reported previously.
  
  
  METHODS
  A questionnaire assessing postoperative pain, use of pain medications and return to activities was sent to the last 100 renal donors who underwent nephrectomy at our institution through the 11th rib (flank incision, group 1) and the last 100 patients who underwent radical nephrectomy through the 8th to 10th rib (thoracoabdominal incision, group 2). A total of 52 group 1 and 42 group 2 questionnaires were returned. Pain was assessed at 4 periods using a visual analog scale.
  
  
  RESULTS
  Length of stay was the same in both groups. There were no differences between groups in terms of pain severity on postoperative day 1, on day of discharge home, 1 month postoperatively and at the time of study (p >0.05). There were no significant differences between groups in times following surgery when pain completely disappeared, when pain medications were discontinued, and when the patient returned to daily activities and work (p >0.05).
  
  
  CONCLUSIONS
  Morbidity was comparable for thoracoabdominal and flank incisions in terms of incisional pain, analgesic requirements after discharge home and return to normal activities.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: J L
authors.initials: JL
authors.lastname: Duque
authors.forename: K C
authors.initials: KC
authors.lastname: Guimaraes
authors.forename: J
authors.initials: J
authors.lastname: Dicanzio
authors.forename: K R
authors.initials: KR
authors.lastname: Loughlin
authors.forename: J P
authors.initials: JP
authors.lastname: Richie
mesh_terms: D000005:Abdomen; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D013909:Thorax; D013997:Time Factors