Primary and prosthetic repair of acquired chest wall hernias: a 20-year experience

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.