Novel Fixation Technique for the Surgical Repair of Lung Hernias

doi:10.1016/j.athoracsur.2008.12.032

The Annals of Thoracic Surgery

Volume 88, Issue 3, September 2009, Pages 1034-1035

https://doi.org/10.1016/j.athoracsur.2008.12.032 Get rights and content

We describe a novel technique for dealing with the rare complication of post-traumatic or post-thoracotomy lung herniation. The method uses techniques and fixation devices that have been developed for stabilization and fixation of the spine and surgical management of scoliosis. It allows for a secure, reliable, and easily reproducible fixation of the chest-wall in patients with large intercostal lung hernias using standard spinal instruments.

Section snippets

Technique

The patients were placed in a standard lateral-decubitus position after double-lung ventilation and isolation of the appropriate lung. A thoracotomy incision centered over the palpable hernia was performed, and any redundant pleural tissue associated with the hernia was resected. Associated diaphragmatic defects were closed with interrupted nonabsorbable sutures (in 1 patient). A laminar hook passer was used subperiosteally to develop a plane for seating the laminar hooks on the superior aspect

Comment

Previous methods reported in the literature include direct suturing, mesh repairs, and occasionally more complex muscle flaps [3, 5]. Most methods rely on approximating ribs where possible and closure of soft tissue surrounding the hernia sac. We believe that the laminar hook fixation uses the strength of the bony anatomy of the chest wall to prevent recurrence. By using scoliosis fixation devices designed for use in children and adolescents, a low profile was maintained. The repair was not

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J Thorac Cardiovasc Surg
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O.A. Minai et al.
Hernia of the lung: a case report and review of literature
Conn Med
(1997)

There are more references available in the full text version of this article.

Cited by (11)

Traumatic thoracic rib cage and chest wall hernias: A review and discussion of management principles
2021, American Journal of Surgery
Citation Excerpt :
As an adjunct to the hernia repair, rib fixation devices can be utilized to reapproximate complex rib fractures, which can significantly reduce the size of the hernia defect that then requires either tissue or mesh closure (Fig. 7). Various rib fixation devices have been described in previous case reports including standard rib plates to laminar hooks originally designed for spine stabilization surgery.38 When requiring the use of rib plating for chest wall stabilization, thin mesh has oftentimes been used in an underlay to reinforce the pleural space and fixed to overlying ribs through the muscle.39
Traumatic thoracic or chest wall hernias are relatively uncommon but highly challenging injuries that can be seen after a variety of injury mechanisms. Despite their description throughout history there remains scant literature on this topic that is primarily limited to case reports or series. Until recently, there also has been no effort to create a reliable grading system that can assess severity, predict outcomes, and guide the choice of surgical repair. The purpose of this article is to review the reported literature on this topic and to analyze the history, common injury mechanisms, likely presentations, and optimal management strategies to guide clinicians who are faced with these challenging cases. We also report a modified and updated version of our previously developed grading system for traumatic chest wall hernias that can be utilized to guide surgical management techniques and approaches.
Lung hernia provoked by a cough fit
2015, Revue de Pneumologie Clinique
Les hernies pulmonaires sont rares et leur pathogénie peu décrite. Elles sont définies par la protrusion de parenchyme pulmonaire à travers la paroi thoracique : espace intercostal, hiatus inter-costo-claviculaire, sus-claviculaire ou diaphragmatique. On distingue classiquement les hernies congénitales des hernies acquises. Ces dernières sont généralement post-traumatiques ou post-opératoires mais peuvent être provoquées par des efforts de toux. Le diagnostic clinique, souvent évident, est confirmé par l’analyse radiographique mais surtout tomodensitométrique. Les risques principaux sont l’incarcération et la nécrose pulmonaire, voire la détresse ventilatoire par respiration paradoxale, en cas de volumineuse hernie. Le traitement, en règle chirurgical, n’est pas univoque et doit prendre en compte la localisation, la taille, la durée d’évolution et le contexte possiblement septique. Nous rapportons le cas d’une hernie basi-thoracique droite provoquée par un effort de toux chez un patient bronchitique chronique.
Lung hernias are rare and their pathogenesis is few described. They are defined as the protrusion of lung parenchyma through the chest wall: intercostal space, inter-costo-clavicular, supra-clavicular or diaphragmatic hiatus. Lung hernias are classically divided into congenital and acquired hernias. Those are usually post-traumatic or post-surgical but can be provoked by cough. Clinical diagnosis is often evident but is confirmed by chest radiograph and especially computed tomography. Major risks are lung incarceration and necrosis but also ventilatory distress due to paradoxical respiration, in case of large defect. Treatment is first and foremost surgical but debated and should consider the localization, the size, the length of evolution and the possible infectious context. We report the case of a right basi-thoracic lung hernia induced by a cough fit, in a patient with chronic bronchitis.
A new technique of pulmonary hernia surgical repair using intramedullary titanium implants
2015, Kardiochirurgia i Torakochirurgia Polska
Primary and prosthetic repair of acquired chest wall hernias: A 20-year experience
2014, Annals of Thoracic Surgery
Citation Excerpt :
Alternatively, the use of biological mesh may represent an acceptable alternative to permanent materials, potentially acting as a matrix for cellular ingrowth over time. The use of titanium hardware to reapproximate the intercostal space has been described [17]. However, such hardware can be costly and the advantage of rigid fixation over pliable mesh repair remains unclear.
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.
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.
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.
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.
Reconstructive surgery for late complications after blunt chest wall trauma
2023, Pirogov Russian Journal of Surgery
Repair of lung herniation with titanium prosthetic ribs and Prolene mesh
2016, Asian Cardiovascular and Thoracic Annals

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How to do itNovel Fixation Technique for the Surgical Repair of Lung Hernias

Section snippets

Technique

Comment

Ann Thorac Surg

J Thorac Cardiovasc Surg

Hernia of the lung: a case report and review of literature

Conn Med

How to do it
Novel Fixation Technique for the Surgical Repair of Lung Hernias