Intercostal Lung Hernias Presenting After Minimally Invasive Cardiac Surgery

Area of Science:

• Cardiothoracic Surgery
• Surgical Oncology

Background:

• Minimally invasive cardiac surgery (MICS) is increasingly common.
• Lung hernias, particularly intercostal types, are emerging complications of MICS.
• Acquired lung hernias include postoperative, traumatic, pathologic, and spontaneous types, with intercostal hernias being most prevalent.

Purpose of the Study:

• To describe the incidence and characteristics of intercostal lung hernias following MICS.
• To review the factors contributing to intercostal lung hernia development.
• To outline the management approach for these hernias.

Main Methods:

• Retrospective review of patients undergoing MICS via mini-thoracotomy from 2010-2022.
• Exclusion of mini-sternotomies.
• Analysis of incision types and contributing factors, with description of repair techniques.

Main Results:

• Nine cases of intercostal lung hernias were identified among 803 adult patients undergoing MICS via mini-thoracotomy.
• Hernias occurred at previous incision sites.
• Common locations included right 2nd intercostal parasternal (aortic valve) and right 4th intercostal lateral (mitral valve) mini-thoracotomies.

Conclusions:

• Intercostal lung hernias are a potential complication of MICS.
• Meticulous wound closure is essential for prevention.
• Prompt diagnosis and surgical repair, preferably with video-assisted thoracoscopic mesh, are crucial for optimal outcomes.