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November 1927


Arch Surg. 1927;15(5):799-828. doi:10.1001/archsurg.1927.01130230135009


Surgical Technic.  —Chauvin1 reported a case in which secondary nephrectomy was performed by means of thoracophrenolaparotomy. Several years previously the patient had been struck by a bullet, which had broken the tenth rib, perforated the pleural culdesac, and finally stopped in the right lobe of the liver. When the kidney was removed, it was found embedded in a thick, hard, fibrous mass. As sufficient exposure could not be obtained, even with resection of the twelfth rib, the pleural culdesac and the diaphragm were incised up to the ninth rib, which permitted ample operating space. Adhesions from an earlier empyema prevented pneumothorax.Roseno2 expressed the belief that pyelotomy is much superior to nephrotomy, if it can be performed. He stated that of 1,767 nephrotomies reported in twenty-five years 85 were secondary; 102 patients died, a mortality of 5.8 per cent. In contrast to this, in 950 pyelotomies reported