Surgical treatment of intercostal hernia with implantation of polypropylene mesh

Primary thoracoabdominal hernias

BACKGROUND

Primary thoracoabdominal hernias involve the triad of an intercostal hernia, abdominal wall hernia, and diaphragmatic hernia. We report a case series of this rare entity and describe the evolution and outcomes.

METHODS

We completed a retrospective analysis of thoracoabdominal hernia repairs performed January 2010-April 2019 at Prisma Health-Upstate and Carolinas Medical Center. This includes all patients with spontaneous defects, excluding incisional hernias or those resulting from external trauma.

RESULTS

Of 16 patients with thoracoabdominal hernias, 15 patients developed hernias after forceful coughing and one patient developed a hernia after strenuous physical activity. Seven patients required at least one additional intervention; two for recurrence; two for recurrence of original intercostal repairs done elsewhere; two for wound complications; and one had a missed abdominal wall component.

CONCLUSIONS

Primary thoracoabdominal hernias require a high index of suspicion. Durable repair involves complex reconstruction of the thoracoabdominal wall including the diaphragm, intercostal space, rib fracture fixation, and mesh reinforcement of the abdominal wall with permanent fixation constructs.

Thoracotomy Wound Dehiscence After Lung Transplant Is an Effective Surgical Solution: A Case Report

Post-thoracotomy wound dehiscence after a lung transplant carries with it morbidity in the postoperative period. While this complication has been widely reported in the literature after a clamshell incision, the thoracotomy dehiscence's surgical solution has not received much emphasis. We present an original technical solution to deal with this complication, performed successfully in a 62-year-old woman diagnosed as having idiopathic pulmonary hemosiderosis after a single lung transplant. This surgical treatment consists of necrotic rib tissue removal, pleural effusion drainage, pulmonary adhesion removal, and chest wall defect reparation with bioabsorbable mesh. This operative technique results safe and effective for thoracotomy dehiscence reparation.

Repair of lung herniation with titanium prosthetic ribs and Prolene mesh

We present a rare case of intercostal lung herniation due to blunt trauma. A 40-year-old man was admitted to our hospital with lung herniation due to falling off a donkey. Computed tomography demonstrated a fracture of the 8th left rib, a comminuted fracture of the 9th rib, and lung herniation into the 8th intercostal space. The herniation was repaired using a titanium prosthetic rib, a rib plate, and Prolene mesh via a thoracotomy.

[Spontaneous pulmonary hernia: report of a case]

Pulmonary hernia is a protrusion of lung tissue through a defect in the chest wall. Its origin can be congenital or acquired; spontaneous presentation is the least frequent. We report a case of spontaneous intercostal pulmonary hernia with a brief description of the disease. In this case, the patient developed a hematoma in the left hemithorax associated to pain at the base of the left hemithorax after a Valsalva's maneuver. The images obtained by thoracic CT scan revealed the existence of a left intercostal hernia. After radiological diagnosis, surgical treatment of the defect was performed with good results.

Primary and Prosthetic Repair of Acquired Chest Wall Hernias: A 20-Year Experience

BACKGROUND

Chest wall herniation has been described after thoracotomy, trauma, and violent coughing episodes. Few studies have examined risk factors associated with chest wall herniation or predictors of complications after surgical repair.

METHODS

A divisional database identified all patients who underwent chest wall herniorrhaphy between 1992 and 2011. Data were collected on patient age, sex, body mass index (BMI), cause and location of hernia, comorbidities, duration and technique of herniorrhaphy, postoperative complications, and hospital length of stay. Risk factors for chest wall herniation were then examined, and primary repair was compared with prosthetic repair for differences in postoperative morbidity.

RESULTS

Twenty-seven consecutive patients underwent chest wall herniorrhaphy. Hernias most commonly occurred on the right side, in the fifth intercostal space, contained lung, and were chronic in nature. Pain was the presenting symptom in all but 4 patients. The most frequently observed comorbidities were obesity, chronic obstructive pulmonary disease (COPD), oral steroid use, and diabetes mellitus. Primary repair was performed in 18 patients and mesh repair in 9 patients, with a median operative time of 116 minutes. Excluding the 4 acute hernias repaired during the same admission as the initial thoracotomy, postoperative complications occurred in 22% of patients who underwent prosthetic repair and 42% of patients who underwent primary repair (p=0.4). Median hospital stay did not differ between herniorrhaphy techniques.

CONCLUSIONS

Previous thoracotomy, obesity, COPD, steroid use, and diabetes mellitus are common in patients in whom chest wall hernias develop. Prosthetic herniorrhaphy is not associated with an increased risk of postoperative complications relative to primary repair.

Acquired abdominal intercostal hernia: case report and systematic review of the literature

PURPOSE

The protrusion of abdominal viscera through an intercostal space under an intact diaphragm is a very rare condition. The aim of this study is to elucidate the etiology, clinical features, and therapeutic options on what several authors call "abdominal intercostal hernia" (AIH).

METHODS

A typical case of AIH of the 9th left intercostal space in a 48-year-old man is presented. A literature search was conducted on the Medline and Scopus databases. Only acquired AIHs (AAIHs) were considered, while lung, transdiaphragmatic, and congenital intercostal hernias were excluded.

RESULTS

Eighteen studies met selection criteria and a total of 20 patients were useful for analysis. Etiology was related mainly to traumatism (65 %) or to previous surgery (20 %). The intercostal defects were mostly located under the 9th rib without significant differences as to side. The main symptom was chest swelling (85 %), often associated with discomfort or pain (76 %). Acute complications such as incarceration and strangulation occurred in three patients. CT was the most employed diagnostic tool (80 %). Early diagnosis was made in 25 % of cases. Seventeen patients underwent hernia repair with either open (73 %) or laparoscopic approach (28 %), and various techniques with and without prosthesis were described. Recurrence occurred in 28.6 % of patients, during a mean follow-up of 8.6 months.

CONCLUSIONS

AAIH should be always suspected when chest swelling occurs after a minor or major trauma, and CT must be promptly performed to rule out diaphragmatic or abdominal viscera injury. This condition requires surgery to prevent serious complications, the first-choice technique should be mesh tension-free repair.

Lung Hernia after Video-Assisted Thoracoscopic Lobectomy

Lung hernias are rare and are most commonly secondary to blunt or penetrating trauma. Few cases have been reported after video-assisted thoracoscopic surgery and only one case after video-assisted thoracoscopic surgery lobectomy. We report a case of lung hernia after video-assisted, thoracoscopic, right upper lobectomy. The hernia was demonstrated by computerized tomography and repaired by minimally invasive techniques. We believe that the combination of removal of a large lung specimen and the presence of emphysema may predispose to lung herniation after thoracoscopic lobectomy. Thoracic surgeons should be aware of this possible complication.

[Herniation of the middle lobe of the right lung due to a coarsely dislocated sternum fracture]

In cases of multiple trauma in patients with an injury severity score (ISS) > or =16 chest injuries, abbreviated injury scale (AIS) > or =3, are also sustained in 57.2% of all patients. Life-threatening complications may occur with lung contusions and rib fractures also in combination with hemothorax/pneumothorax being the most common diagnoses. In addition the lungs can also be functionally impaired by ruptures of the great thoracic vessels or in isolated cases by herniation of lung tissue following tears in the wall of the thorax. A case of multiple trauma in a 44-year-old male (ISS 29) with blunt thoracic trauma resulting in herniation of the middle lobe of the right lung into the subcutaneous tissue due to a coarsely dislocated fracture of the sternum is reported. This still ventilated lung tissue was surgically resituated 4 weeks after the event and the sternum fracture was simultaneously stabilized by plate osteosynthesis. Clinical examination and awareness of the possibility of other injuries (high level of suspicion) are essential. Therefore, standard diagnostic procedures combined with multislice computed tomography during the first examination and reassessment should be included to avoid missed injuries.

Transient lung herniation through a thoracic cage defect: a case report

We report a benign condition of transient lung herniation through a congenital structural defect of the thoracic cage, in a young, otherwise healthy, asymptomatic individual. A brief review of the existing literature on this rare entity is also presented.

Outside-the-ribcage thoracic migration of a spigelian hernia

Lung and spigelian hernia are both extremely rare diseases, and their combined and simultaneous appearance in the same patient, causing the small bowel to shift from the abdomen towards the thorax external to the ribcage is even more unusual. Here, we report such a case, supported by comprehensive iconography and a detailed discussion of the hypothetical pathogenesis.

Transthoracic hernia after harvesting a costal and latissimus dorsi flap

Ribs are one of the most widely used grafts in craniofacial surgery. Harvesting a costochondral graft is easy and safe. The main complications are related to pneumothorax and chest-wall deformity in children. A complication is described in a patient who underwent an orbito-zygomatic reconstruction with two contiguous ribs and a latissimus dorsi free flap, and who subsequently developed a transthoracic hernia that required reconstruction with polypropylene mesh.