The Incidence and Management of Pleural Injuries Occurring during Open Nephrectomy

Objective . To evaluate the incidence, management, and risk factors of pleural injuries occurring during open nephrectomy. Methods . Between June 2004/and June 2008, 165 patients (167 renal units) underwent open simple ( n = 37, 22.2%), partial ( n = 39, 23.4%) or radical ( n = 91, 54.5%) nephrectomy in our institution. Results . Flank, Chevron, and abdominal midline incisions were used in 148(88.6%), 17(10.2%), and in 2(1.2%) surgical procedures, respectively. Ribs were excised in 109(65.3%) procedures (11th rib, 10th-11th ribs, and 11th-12th ribs). Intraoperative pleural injuries were detected in 20(12%) procedures, 16(80%) were treated successfully with simple evacuation technique, and 4 required chest tube insertion. Age, sex, surgery type, incision type, and surgery site were not associated with pleural injury occurrence ( P > .05). Rib resection was the only parameter associated with pleural injury occurrence. Conclusion . Pleural injuries occur in 12% of open nephrectomy procedures, and 80% can be repaired successfully. Few of them (2.4%) need chest tube insertion. Performing rib resection is a significant risk factor for pleural injury occurrence during nephrectomies.