Intracostal Nerve-Sparing Versus Pericostal Rib Suturing in Thoracotomy Closure: Impacts on Postoperative Pain and Neuralgia

Abstract

Background: Thoracotomy remains a fundamental approach in thoracic surgery, but it is frequently associated with significant postoperative pain and the potential development of chronic intercostal neuralgia. The method used for rib approximation during thoracotomy closure plays a pivotal role in influencing these outcomes.Traditional pericostal suturing techniques, which encircle the ribs, have long been the standard. However, this approach risks compressing the intercostal neurovascular bundle, contributing to severe pain and long-term complications. In contrast, newer nerve-sparing methods like intracostal suturing have been developed to mitigate these issues by avoiding direct pressure on intercostal nerves. This review aims to comprehensively compare pericostal
and intracostal rib suturing techniques in thoracotomy closure, focusing on their anatomical implications, impact on postoperative pain, long-term neuralgia, functional outcomes, and patient satisfaction. By analyzing current literature and surgical practices, the article evaluates the efficacy, safety, and clinical significance of nerve-sparing approaches in enhancing recovery and reducing morbidity.