Postoperative Residual Pleural Space: A Risk Factor for Chest Wall Hernia After Thoracoscopic Surgery

Area of Science:

• Thoracic Surgery
• Surgical Complications
• Pulmonary Medicine

Background:

• Chest wall hernia and residual pleural space are known complications after thoracoscopic anatomical lung resection.
• While risk factors for chest wall hernia exist, residual pleural space has not been previously identified as a contributing factor.
• This study explores the potential link between residual pleural space and the development of chest wall hernias.

Purpose of the Study:

• To investigate the hypothesis that a postoperative residual pleural space is a novel risk factor for chest wall hernia after thoracoscopic lung resection.
• To present clinical cases illustrating the occurrence of chest wall hernia in the context of residual pleural space.
• To propose potential preventive measures for chest wall hernias in at-risk patients.

Main Methods:

• Case report analysis of two patients who developed chest wall hernias post-thoracoscopic lung resection.
• Review of patient histories, surgical procedures (3-port thoracoscopic lobectomy and segmentectomy), and postoperative courses.
• Clinical observation and diagnosis of chest wall hernia and residual pleural space.

Main Results:

• Two patients developed chest wall hernias at the incision sites following thoracoscopic lung resections.
• Both patients had a history of residual pleural space during their postoperative recovery.
• No other previously described risk factors for chest wall hernia were identified in these cases.

Conclusions:

• Postoperative residual pleural space may impede incisional wound healing due to air flow, potentially leading to chest wall hernia.
• Residual pleural space is proposed as a newly identified risk factor for chest wall hernia after thoracoscopic surgery.
• Modified closure techniques for video-assisted thoracic surgery incisions in susceptible patients may help prevent incisional hernias.