Management of pleural injuries during retroperitoneal surgical procedures |
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Authors: | Michael Rutledge David Aronoff Werner de Riese Bernhard Mittemeyer |
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Institution: | (1) Department of Urology, Texas Tech University Health Sciences Center, University Urology Associates, Medical Office Plaza, 3502 9th Street, Ste#260, Lubbock, TX 79415, USA |
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Abstract: | Purpose The necessity of a postoperative chest tube for the treatment of pneumothorax after a radical nephrectomy is controversial.
Materials and methods A five-year retrospective study was performed on 91 patients, having undergone a radical nephrectomy. We examined the existence
and length of a pleural rent, presence of a postoperative thoracostomy tube, postoperative pneumothorax, postoperative pneumonia,
postoperative atelectasis, pain scores, hemoglobin saturation, and length of hospital stay with univariate and multivariate
analysis.
Results Incidence of a pleural rent occurred in 29 (36%) of open radical nephrectomy cases; 4 of the 29 cases had a postoperative
thoracostomy tube. There was no significant difference in hemoglobin saturation levels between cases that had no pleural rent,
a pleural rent without a thoracostomy tube, and a pleural rent with a postoperative thoracostomy tube. A pleural rent without
a postoperative chest tube had significantly lower rates of pain score, atelectasis, pneumonia, pleural effusion, and length
of hospital stay compared to individuals with a postoperative chest tube. Patients with a chest tube had a significantly higher
incidence of pain, atelectasis, pneumonia, effusion, and length of hospital stay.
Conclusion Iatrogenic pleural rents treated without a postoperative chest tube show a significant decrease in postoperative complications
of pneumonia and atelectasis, pain score and length of hospital stay. These patients show no significant increases in postoperative
complications; therefore, it appears that postoperative chest tube placement after a pleural injury occurs is of no advantage. |
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Keywords: | Pleural rent Postoperative atelectasis Postoperative pneumonia Postoperative pneumothorax Radical nephrectomy Thoracostomy tube |
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