title: Surgical approach does not affect perioperative respiratory morbidity in living donor nephrectomy: comparison between anterior subcostal incision and flank incision.
abstract: BACKGROUND
  Living donor nephrectomy has been a routine surgical procedure that significantly increased the number of organs for patients with end-stage renal disease. Upper abdominal surgeries, especially when performed with an open approach, usually lead to a postoperative reduction in lung volumes and pulmonary compliance, which may predispose to the development of atelectasis and pulmonary mucus retention, important risk factors for postoperative pulmonary infections.
  
  
  OBJECTIVE
  This study sought to compare lung function impairment, pain, and the incidence of postoperative pulmonary complications among live nephrectomy donors undergoing either an open donor nephrectomy through an anterior subcostal incision (SC) or a flank incision (FL).
  
  
  METHODS
  Between 2006 and 2008, 110 subjects (44 SC/66 FL) had their pulmonary functions (spirometry) and pain (visual analog scale) evaluated preoperatively as well as on postoperative days 1, 2, 3, and 5. Postoperative pulmonary complications were evaluated daily by a pulmonary physician. A chest radiograph was obtained on postoperative day 2 to evaluate the presence of atelectasis.
  
  
  RESULTS
  Both groups were similar before surgery. Patients in both groups showed decreased pulmonary function from day 1 to 3 (P < .05). Subjective pain was increased until day 5 (P < .05) with a higher incidence of atelectasis among 36% FL vs. 25% SC. (P > .05).
  
  
  CONCLUSIONS
  Living donor nephrectomy through either a flank incision or an anterior subcostal incision showed similar degrees of postoperative pain, decreased lung function, and pulmonary complications.
authors.affiliation: Nephrology Division, Hospital do Rim e Hipertensão, UNIFESP, São Paulo, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Chiavegato
authors.forename: J
authors.initials: J
authors.lastname: Medina-Pestana
authors.forename: H
authors.initials: H
authors.lastname: Tedesco-Silva
authors.forename: D
authors.initials: D
authors.lastname: Paisani
authors.forename: J
authors.initials: J
authors.lastname: Fiore
authors.forename: S
authors.initials: S
authors.lastname: Faresin
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011184:Postoperative Period; D001261:Pulmonary Atelectasis / Q000453:epidemiology; D012129:Respiratory Function Tests