Suture-based rib approximation for the repair of minimally invasive surgery-related lung hernia: a case series

Lung hernia is a rare complication of minimally invasive surgery (MIS). Suture-based rib approximation to restore costal margin continuity during MIS-related lung hernia repair has not been reported. We present three cases of repair using suture-based rib approximation for MIS-related lung hernias. Between 2016 and 2025, our department performed four MIS-related lung hernia repairs. Three followed minimally invasive cardiac surgery (MICS), and one followed video-assisted thoracoscopic surgery (VATS). We excluded the MICS case requiring third-rib resection during MICS and Gore-Tex patch for repair. All MICS-related hernias occurred at the right fourth intercostal space; the VATS-related hernia occurred at the left fourth intercostal space. In all three cases, hernial defects were repaired with sutures placed across the intercostal space between the upper and lower ribs. No perioperative mortality, morbidity, or recurrence occurred. Suture-based rib approximation demonstrated favorable outcomes. Further case accumulation is necessary to identify risk factors and establish optimal techniques.