title: Body image alteration after flank incision: relationship between the results of objective evaluation using computerized tomography and patient perception.
abstract: OBJECTIVE
  We evaluated subjective and objective alterations in body image and configuration of patients who underwent urological surgery via a flank incision.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohara
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ichioka
authors.forename: Naoki
authors.initials: N
authors.lastname: Terada
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.forename: Akito
authors.initials: A
authors.lastname: Terai
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D034861:Abdominal Wall / Q000473:pathology; D001828:Body Image; D005260:Female; D006801:Humans; D007366:Intercostal Muscles / Q000601:surgery; D007668:Kidney / Q000601:surgery*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010465:Perception; D011183:Postoperative Complications / Q000523:psychology*; D011860:Radiography, Abdominal; D012272:Ribs / Q000601:surgery; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000601:surgery*