Renal Surgical Procedures That Cause Horizontal Scars Over the Flank
Open surgical procedures for renal conditions, particularly anatrophic nephrolithotomy and open radical nephrectomy, typically result in horizontal flank incisions that leave horizontal scars over the flank area.
Open Surgical Approaches with Flank Incisions
Anatrophic Nephrolithotomy
- Performed with the patient in the flank position
- Requires a standard flank incision, often with resection of a lower rib
- Used primarily for complex staghorn calculi when other approaches are not suitable 1
- Considered in <1% of patients undergoing stone removal today
- Results in a horizontal scar across the flank area
Open Radical Nephrectomy
- Traditional approach includes a flank incision for kidney access
- Involves removal of kidney, perirenal fat tissue, and sometimes adrenal gland and regional lymph nodes 1
- Remains the gold standard for treatment of complex cases, particularly with venous tumor thrombus 1
Open Partial Nephrectomy
- May utilize a flank approach with horizontal incision
- Used for nephron-sparing surgery in complex tumor cases
- Indicated for tumors in solitary kidneys or bilateral renal tumors 1
Complications of Flank Incisions
Post-Surgical Flank Bulge
- Occurs in approximately 49% of patients undergoing nephrectomy through flank incisions 2
- Results from muscle weakness following the incision
- More common with left-sided nephrectomies
- Represents a permanent deformity with significant impact on quality of life
Other Complications
- Flank incisions are notably painful 1
- Many patients experience numbness, paresthesia, and weakness of the abdominal wall 1
- Rare complications include intercostal herniation (only a few reported cases) 3
- Typical postoperative disability period is six weeks 1
Modern Alternatives to Open Flank Approaches
Laparoscopic and Robotic Approaches
- Laparoscopic and robot-assisted procedures have largely replaced open surgery for many renal conditions 1
- These minimally invasive approaches use small port incisions rather than large flank incisions
- Both transperitoneal and retroperitoneal laparoscopic approaches are used depending on tumor location 1
- Laparoscopic approaches avoid the horizontal flank scar and associated complications
Patient Positioning Considerations
- Modified flank positioning techniques have been developed for laparoscopic procedures to reduce complications 4
- These techniques avoid arm elevation on an arm board, reducing risk of brachial plexus neuropraxia
Clinical Implications
The high rate of postoperative flank bulging (49%) and other complications associated with flank incisions supports the current trend toward minimally invasive approaches for renal surgery 2. When considering surgical approach, the potential for permanent flank bulge and scar should be incorporated into decision-making, particularly when choosing between open partial nephrectomy and laparoscopic procedures.
For patients requiring open surgery with flank access, they should be counseled about the likelihood of a permanent horizontal scar and possible flank bulge as a long-term consequence of the procedure.