title: Routine postoperative chest radiography is not needed after flank incisions with eleventh rib resection.
abstract: BACKGROUND
  We wanted to determine whether routine postoperative chest radiography is needed after surgery with eleventh rib resection.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Urology Clinic, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Atmaca
authors.forename: Ziya
authors.initials: Z
authors.lastname: Akbulut
authors.forename: Serkan
authors.initials: S
authors.lastname: Altinova
authors.forename: Alper
authors.initials: A
authors.lastname: Caglayan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tuzlali
authors.forename: M Derya
authors.initials: MD
authors.lastname: Balbay
mesh_terms: D000315:Adrenalectomy; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography / Q000706:statistics & numerical data; D012272:Ribs / Q000601:surgery*; D014513:Ureter / Q000601:surgery; D013520:Urologic Surgical Procedures