Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique

Intercostal lung herniation; a rare complication after mini-transthoracic approach (TTA) for thoracic disc herniation. Two case reports and review of literature

BACKGROUND

Lung herniation is a rare condition, most often due to thoracic injury, but has also been described as a complication following cardiothoracic surgery. Here, we report two cases of post-surgical lung herniation following a neurosurgical mini-transthoracic (mini-TTA) for treatment of thoracic herniated discs. With this report we aim to make surgeons aware of this rare complication, review existing literature on surgical repairs and describe our novel correction technique using video assisted thoracic surgery (VATS) and a combination of mesh covering the muscle defect internally and nitinol rib plates for rib approximation on the outside of the thoracic cavity.

CASE DESCRIPTION

Patient A was an 85-year-old man who presented with a subcutaneous swelling at the site of surgery following a left sided mini-TTA. Computed tomography (CT) revealed pulmonary tissue herniation. He underwent VATS guided reconstruction. Using two Ventralex meshes covering the defect on the inside and a NiTi-rib H-plate for rib approximation. Patient B was a 73-year-old woman who developed pulmonary complaints with a soft mass at the surgery site after a left sided mini-TTA. She also underwent VATS guided reconstruction. A large Sempramesh composite mesh and two NiTi-Rib H-plates were used. Recovery was uncomplicated and follow-up revealed no recurrence in both cases.

CONCLUSION

These cases should make surgeons aware of the possibility of post-surgical development of lung herniation and describe successful correction using a combination of mesh material and NiTi-Rib H-plates through a VATS technique.

A 64-Year-Old Man with Traumatic Right Middle Lobe Lung Herniation Successfully Managed Conservatively

Patient: Male, 64-year-old

Final Diagnosis: Right lung hernia • trauma

Symptoms: Chest pain • shortness of breath

Medication: —

Clinical Procedure: Chest tube • conservative management

Specialty: Thoracic Surgery • Radiology • Trauma Surgery