To evaluate the frequency and conservative management of pneumothorax following incidental pleurotomy by flank incision in living donor nephrectomy.
Patients and Methods: Between Feb 1989 to May 2006, 562 living donors (328 males and 234 female; mean age 26.5, ranged 18-54) were nephrectomies via exterapritoneal, reteropleural flank incision. Incisions made in lateral decubitus position, intercostally or by an 11th rib resection. Left kidneys were removed in 468 patients and right in 94 (L/R=5/1). Rib resection was done in 259 patients (46%). If incidental pleurotomy occurred, primary repair was done after a deep inspiration and control chest X-Ray was taken in recovery room. Incidental pleurotomy occurred in 118 cases (21%), that were 95 (80.5%) in left and 23 (19.5%) in right nephrectomies. Pleural injuries lengths were 4-75mm (mean 32mm), that all of them were recognized intraoperatively and immediate primary repair was done. Pleurotomy was occurred with and without rib resection in 27% (70 donors) and 16% (48 donors) respectively which had significant difference in statistical analysis (p<0.001). Mild pneumothoraxes (<10%) occurred in 6 cases (1.1%) that were associated with respiratory symptoms. All patients managed conservatively without chest tube. Although pleurotomy is a common complication in donor nephrectomy, but incidence of pneumothorax is not high if primary pleural repair is done intraoperatively. Rib resection increases the possibility of pleural injuries. If pleural injuries recognized and repaired intraoperatively, insertion of chest tube is not usually necessary and routine postoperative chest radiography for pneumothorax diagnosis is not necessary too, except in patients with respiratory symptoms.