Surgical treatment of intercostal hernia with implantation of polypropylene mesh

Abstract

The intercostal hernia of the lung is a very rare extraordinary disease that requires operation because of the complaints and potential complications. The authors review cases of their operations and analyze the subsequence and treatment. Three patients have been treated for intercostal lung hernia in our treatment. The causes of this disease were a previous thoracotomy in one case and fits of coughing in the other two cases. The diagnosis was set up on the grounds of the specific clinical symptoms, thoracic X-ray and CT scan. The hernia was dissolved with percostal stitches and with the suture of the thoracic musculature in two cases. Plastic operation of the thoracic wall by implanting a polypropylene surgical mesh (Prolen, Ethicon, Johnson & Johnson) was performed in the case of the third patient and later in the first two patients due to recrudescence. In one case the authors were constrained to resect the dystelectasial lung in the hernial sac. The three patients had been operated five times. Relapse of hernia was detected in two patients, in whom the intercostal space had been reconstructed with percostal stitches. We did not detect any relapsing in those two patients at 33 and 66 months after the second operation with mesh implantation. The third patient who got mesh implant immediately did not relapse 12 months after the operation. Intercostal lung hernia is an indication of operation. A plastic operation of the thoracic wall combined with the implantation of a surgical mesh is recommended to close the hernial orifice, which is suitable for treating both primary and relapsed hernias. Recurrence is rare in those patients treated with this method.

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

“…In reference to the underlying mechanism, a sudden growth of intrathoracic pressure is in the background, which can be caused by coughing, emesis, lifting heavy weights; usually combined with attenuation of the thoracic wall [2]. …”

Lung herniation: a rare complication in minimally invasive cardiothoracic surgery☆

“…It is usually not very difficult to diagnose the disease with the knowledge of the patient's history and the specific clinical symptoms and physical examination [7,8,13]. The patient may present with a well-circumscribed bulge increasing in size by expiration and decreasing by inspiration or may be evident during coughing or Valsalva maneuver [4,14].…”

“…Iatrogenic postoperative lung hernias are commonly reported anteriorly after less extensive surgical procedures, such as thoracoscopy [10] or minimally invasive cardiac surgery [11][12][13]. The surgical approach of choice in less extensive procedures is the anterior 'mini' thoracotomy because it provides both a safe and effective alternative to extracorporeal circulation and to long and painful incisions.…”

A clinical case of thoracic hernia after resection of the esophagus for its cancer

“…При физикаль-ном осмотре следует обратить внимание на наличие асим-метрии грудной клетки, подкожной эмфиземы и призна-ков развития гидро-и пневмоторакса. Патогномоничным является деформация грудной клетки, увеличивающаяся в размере при выполнении пробы Вальсальвы [14]. Ос-новным методом диагностики является рентгеноскопия, которая позволяет визуализировать момент выхода части легкого в грыжевой мешок при повышении внутригруд-ного давления (кашель, проба Вальсальвы) [15,16].…”

“…При этом в ка-честве пластического материала могут быть использованы как аутотрансплантаты, так и синтетические материалы [18]. Проанализировав имеющиеся разрозненные данные по частоте развития рецидивов, можно сделать вывод о предпочтительности использования варианта реконструк-ции с применением пластического компонента [14].…”