Open renal approach: Comparative analysis of sub-costal incision versus trans-costal incision with excision of 12^th rib

Objective: To compare the outcome of sub-costal incision with trans-costal incision & 12^th rib resection in the surgical approach for benign renal disease. Methodology: It is a prospective, analytical, comparative study using randomized controlled trial (RCT), conducted at Fatima hospital-Baqai medical university (Karachi), from June 2005 to December 2008. In total 54 patients were enrolled in the study, who either underwent pyelolithotomy or nephrectomy via sub-costal (group A: 27 patients) or trans-costal incision (group B: 27 patients). Incision time, duration of operation, postoperative pain, duration of hospital stay, & peroperative and postoperative complications were noted. Results: Incision time & duration of operation were longer in group B patients (p-value 0.002 & 0.029 respectively); pain perception was also markedly high in this group (p=0.001). Total period to stay in hospital was marginally higher in group B (p=0.212). Peroperative & postoperative complications were also slightly higher in group B patients (p-value 0.064 & 0.838 respectively). Conclusion: Sub-costal renal approach provides adequate exposure, is quick, safe and less painful.