Lung herniation as a complication of minimally thoracic surgery

Introduction: Lung herniation defined as a protrusion of the lung parenchyma with pleural membranes through a defect of the thoracic wall is a rare entity. As minimally invasive cardiothoracic procedures evolve, different complications may be evident such as lung herniation. A retrospective review of patients submitted to minimally invasive thoracic (uniportal VATS) cardiac or transplant surgery revealed 18 patients with lung herniation and this experience is analyzed. Material & Method: Thirteen male (72%) and 5 female ranging in age between 23 and 77 years were admitted for a lung hernia. The location was right in 9 cases, left in 7, and finally, in 2 cases the herniation was bilateral. The majority were symptomatic. The bulge was present regardless of straining in all cases and the chest wall defect was palpated. Chest tomographic scan showed that a large portion of the lung had herniated through the defect in the chest wall and defined the extent of the hernia. The surgical procedure included identification of the hernial sac and reconstruction with a prosthetic patch. In 3 cases a partial decortication was needed. Results: There was no peri-operative mortality or morbidity. Patients were discharged within 4 to 7 days postoperatively. In a follow up of 12 months no recurrence was observed. Conclusions: Prevention is still the “best method” in order to avoid a lung hernia. Hernias with persistent pain and entrapped lung need surgical intervention in order to avoid serious complications such as recurrent pulmonary infections and hemoptysis due to strangulation. The use of a prosthetic mesh to close the defect is suggested because of favorable late results.