Pulmonary hernia after thoracoscopy: case report

Abstract

Pulmonary hernia is a rare medical condition with an old history that dates back to the XV century. About a half of cases have been reported after trauma. The pulmonary hernia is also known as a complication of open thoracic surgery. Although it has been reported after closed chest surgery, it seems to be underreported. We report four cases of pulmonary hernia after minor or major thoracoscopic procedures.We present clinical data of patients and discuss clinical features and prevention of this adverse effect of thoracoscopic surgery. Three patients were symptomatic, a painful bulge increasing with chest strain at the specimen extraction incision scar, and they were operated on. The diagnostic of pulmonary hernia is not always straightforward at clinical examination which is the milestone of the diagnostic. CT scan can mislead, especially when it is not performed under the Valsalva maneuver. The pulmonary hernia following thoracoscopy is treated like other hernias. The peculiarity of the pulmonary hernia following the VATS would be, the hernia orifice is often a tiny opening, that is a theoretical risk of pulmonary strangulation; its anterior inferior location is a risk of possible enlargement of the hernia to the abdomen. For these 2 reasons some would directly operate almost each pulmonary hernia after thoracoscopy. We think that, only symptomatic patients with either persistent or worsening symptoms should have a surgical repair. The postoperative outcome is uneventful. More care is expected in the diagnostic phase. The pulmonary hernia should be discussed as differential diagnostic for a patient who has been operated on after a thoracoscopy with lingering parietal symptoms, especially pain.