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Lung herniation: a rare complication in minimally invasive cardiothoracic surgery

Department of Cardiac, Thoracic, Transplantation & Vascular Surgery, Hanover Medical School, Hanover, Germany

Received 1 October 2007; received in revised form 23 December 2007; accepted 16 January 2008.

^_* Corresponding author. Address: Konstantinoupoleosstr. 34A Holargos, 15562 Athens, Greece. Tel.: +30 210 6510388; fax: +30 210 6547695. (Email: kallatha{at}otenet.gr).

Objective: 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 cardiac procedures evolve, different complications may be evident such as lung herniation. A retrospective review of all patients submitted to minimally invasive cardiac or transplant surgery through anterior mini-thoracotomy at our department revealed 16 patients with lung herniation and this experience is analyzed. Materials and methods: From 1996 through 2007, 12 male (75%) and 4 female ranging in age between 23 and 77 years submitted prior either to minimally invasive cardiac or transplant surgery were admitted at our department for a lung hernia. The location was right in eight cases, left in six, and in two cases the herniation was bilateral. The majority of our patients were symptomatic. Twelve of them (75%) complained of pain. The bulge was present regardless of straining. Diagnosis was confirmed by chest X-ray and tomographic scan in all of them. The surgical procedure included identification of the hernial sac and reconstruction of the defect. A variety of materials were used for chest wall reconstruction such as Vicryl and Goretex mesh. Results: There was no perioperative mortality or morbidity. Patients were discharged within 5–7 days postoperatively and in a follow up of 3 months to 8 years no recurrence was observed. Conclusions: (1) Since the thoracic cage has inherent weakness anteriorly near the sternum, attention is needed when the anterior approach is used. (2) Hernias with persistent pain and entrapped lung usually need reconstruction with a patch in order to avoid late complications such as recurrent pulmonary infections and hemoptysis due to strangulation.

Key Words: Lung herniation • Minimally invasive cardiac surgery • Anterior thoracotomy