Comparing the effects of intercostal and subcostal flank incision on post-operative pain and incisional hernia or bulge in patients undergoing open kidney surgery: A randomized clinical trial

BACKGROUND: Flank incision, a common approach in kidney surgery, has several types. This study was carried out to examine the effect of using subcostal and intercostal flank incisions on postoperative pain, incisional hernia or bulging, and incision time and wound closure time in patients undergoing open kidney surgery. MATERIALS AND METHODS: This randomized clinical trial was conducted Iran (2023-2024). Sixtyfour patients were randomly divided into two groups of 32 patients, subcostal and intercostal, based on available sampling technique. The Visual Analog Scale was used to assess post-operative pain. The abdominal wall asymmetry (AWA) technique was used for both hernia and bulge, and clinical examination was done by a urology surgeon for diagnosing AWA. Data analysis was done using SPSS-23. RESULTS: In the subcostal group, a higher incidence of AWA was observed when compared to the intercostal group at 6 months post-operation, and this difference was statistically significant (P = 0.039). However, there was no significant difference between the two groups at 3 months post-operation in this regard (P > 0.05). The mean pain score of patients at 24 and 72 h post-operation was significantly higher in the intercostal group than in the subcostal group (P < 0.05); however, at the first hour and on day 7 post-surgery, no significant difference was found between the two groups in this regard (P > 0.05). In addition, no significant differences existed between the two groups regarding incision time and wound closure time (P > 0.05). CONCLUSION: Intercostal incision, when compared to subcostal incision, was associated with lower probability of development of hernia or bulge, in spite of its higher-level post-operative pain.