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Background
Primary thoracoabdominal hernias involve the triad of an intercostal hernia, abdominal wall hernia, and diaphragmatic hernia. We report a case series of this rare entity and describe the evolution and outcomes.Methods
We completed a retrospective analysis of thoracoabdominal hernia repairs performed January 2010–April 2019 at Prisma Heal...
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PurposeWe introduce a novel approach to the surgical repair of Morgagni hernias (MHs) utilizing the robotic transabdominal preperitoneal repair (rTAPP) approach. Borrowed from our previous and robust experience with rTAPP repairs for hernias of the anterior abdominal wall, this technique boasts the benefits of hernia sac reduction, the use of an un...
Citations
... The definition varies among published literature, but typically TH are described as disruption of both abdominal and thoracic musculature and can also include a diaphragm component. Numerous terms have been used interchangeably with TH, including intercostal hernia, transdiaphragmatic intercostal hernia and thoracolumbar hernia [1]. Some authors have proposed additional classification to help standardize reporting of these rare hernias, but categorization has not yet been adopted by current hernia societies [2,3]. ...
Thoracoabdominal hernias remain a rare and poorly understood entity. Data remain sparse as terminology varies in the literature and case reports demonstrate wide variability in technique. We present a novel approach for repair of thoracoabdominal hernias using the robotic platform.
Two patients underwent a robotic thoracoabdominal hernia repair in June 2022. They were followed for 1 year with CT scans every 6 months to exclude recurrence. Patient demographics and peri-operative details including defect size, closure technique, mesh size, length of stay, and complications were reported.
Both patients successfully underwent a robotic repair of a thoracoabdominal hernia, addressing the intercostal hernia, diaphragmatic disruption, and flank hernia discretely during the operation. One patient had an uneventful recovery and discharged on post-operative day 3; the other developed a small bowel obstruction due to an early port site hernia which required surgical intervention. He eventually discharged on post-operative day 9. At one year, there is no clinical or radiographic evidence of recurrence for either patient.
Robotic thoracoabdominal hernia repair is feasible and offers a minimally invasive repair option for these extremely complex hernias.
... Abdominal incisional hernia can lead to respiratory insufficiency and circulatory system dysfunction and even abdominal organ injury, such as intestinal obstruction and intestinal rupture, as well as a negative impact on the stability of the spine and thorax. The quality of life of patients is seriously affected (van Ramshorst et al., 2012;Paulo et al., 2020;Sahin et al., 2020;Shao et al., 2020;Alayon-Rosario et al., 2021;Hoffman et al., 2021;Jensen et al., 2021;Licari et al., 2021;Soare et al., 2021;Cassese et al., 2022). ...
Background: In this study, a new composite biological mesh named SFP was prepared by combining silk fibroin with polypropylene mesh. The mechanism and clinical application value of the SFP composite mesh were explored.
Methods: The fibrous membrane was prepared by electrospinning of silk fibroin. The silk fibrous membrane was adhered to the polypropylene mesh by fibrin hydrogel to make a new composite mesh. The characterizations were verified by structural analysis and in vitro cell experiments. A total of 40 Sprague–Dawley rats were randomly divided into two groups, and 20 rats in each group were implanted with the SFP mesh and pure polypropylene mesh, respectively. The rats were sacrificed in batches on the 3rd, 7th, 14th, and 90th days after surgery. The adhesion degree and adhesion area on the mesh surface were compared, and a histopathological examination was carried out.
Results: In vitro cell function experiments confirmed that the SFP mesh had good cell viability. The control group had different degrees of adhesion on the 3rd, 7th, 14th, and 90th days after surgery. However, there was almost no intraperitoneal adhesions on the 3rd and 7th days after surgery, and some rats only had mild adhesions on the 14th and 90th days after surgery in the SFP group. There were statistically significant differences in the postoperative intraperitoneal adhesion area and adhesion degree between the two groups (p < 0.05). Histopathological examination confirmed that the mesenchymal cells were well arranged and continuous, and there were more new capillaries and adipocyte proliferation under the mesenchymal cells in the SFP group.
Conclusion: The SFP mesh shows good biocompatibility and biofunction in vitro and in vivo. It can promote the growth of peritoneal mesenchymal cells. The formation of a new mesenchymal cell layer can effectively reduce the extent and scope of adhesion between the mesh and abdominal organs. The SFP mesh will have a good application prospect in the field of abdominal wall hernia repair.
... All patients in this series underwent operative repair of their thoracoabdominal hernias, at which time the radiographic findings described in this study were confirmed. Recent management algorithms for thoracoabdominal hernias have been proposed which rely heavily on intraoperative identification of various injury patterns including diaphragmatic, intercostal, and abdominal wall defects [9]. We posit that careful preoperative assessment of cross sectional imaging can aid in identification of these defects and may help to prevent the missed injuries leading to recurrence reported in some series [9][10][11]. ...
... Recent management algorithms for thoracoabdominal hernias have been proposed which rely heavily on intraoperative identification of various injury patterns including diaphragmatic, intercostal, and abdominal wall defects [9]. We posit that careful preoperative assessment of cross sectional imaging can aid in identification of these defects and may help to prevent the missed injuries leading to recurrence reported in some series [9][10][11]. A primary limitation in the reporting of this hernia pattern is the lack of uniformity in naming, which has led to challenges in conveying the presence of this rare entity and lack of awareness amongst general and thoracic surgeons. ...
... Further, some have defined TDIH as two distinct defects; one in the diaphragm and another in the intercostal space [3]. This nomenclature fails to identify involvement of the abdominal wall musculature which occurs in greater than 80% of cases in prior series and 100% of cases in our series [9]. Because of this well documented variable involvement of the diaphragm, chest wall, and abdominal wall musculature, we believe that the term thoracoabdominal hernia provides the most broadly encompassing term to identify these defects. ...
PurposeHernias spanning both chest and abdominal walls are uncommon and associated with chest wall trauma, coughing and obesity. This study describes the radiographic appearance of these hernias to guide proper identification and operative planning. Proposed standardized reporting patterns are also presented.Methods
The cross sectional imaging of patients presenting with thoracoabdominal hernias was reviewed. Radiographic reports were supplemented by surgeon imaging review and operative findings during repair. Defect dimensions, hernia content, level of herniation, presence of osseous or cartilaginous disruption of the chest wall and degree of rib displacement were collected. Disruption of myofascial planes was also noted.ResultsSix patients were identified. All hernias occurred below the 9th rib and were associated with complete intercostal muscle disruption. The transversus abdominis was disrupted in all hernias and the internal oblique was disrupted in five of the hernias. The majority (83%) had caudal rib displacement (median 6.8 cm compared to contralateral side). Median hernia width was 10.35 cm (1.6–19.1 cm) and median length was 10.2 cm (1.8–14.3 cm). Five patients had associated bone/cartilage injuries: two with 11th rib fractures, two with combined bone and cartilaginous fractures and one with a surgical rib resection.Conclusion
The typical injury pattern of thoracoabdominal hernias includes disruption of the intercostal muscles, transversus abdominis, and commonly the internal oblique with an intact external oblique. Inferior rib displacement by hernia contents and unopposed pull of the abdominal musculature is common. Osseous or cartilaginous disruption always occurs unless the defect is bounded on at least one side by a floating rib.
Thoracoabdominal hernias are rare and therefore not well represented in the literature. Thoracoabdominal hernias can be congenital or acquired, the latter usually the result of blunt trauma or forceful coughing; however, thoracic and retroperitoneal surgery also account for iatrogenic causes [1–4]. The hernia literature consists of relatively few case reports of thoracoabdominal hernias. In one literature review, 14 total cases were published in the literature spanning a period of 30 years, from 1977 to 2017 [5]. A separate study from 2014 reported on 19 thoracoabdominal hernias [2]. More recently, a two-institution series was published consisting of 16 patients, all with spontaneous, cough-induced thoracoabdominal hernias. This particular series focused on the physiology and optimal surgical repair of these rare hernias [4].KeywordsThoracoabdominal herniaThoracoabdominal zoneTransdiaphragmatic intercostal herniaAbdominal intercostal herniaThoracic intercostal hernia
Spontaneous transdiaphragmatic intercostal hernia is an extremely rare clinical entity featuring dual defects in the diaphragm and chest wall. We report on the case of a 59-year-old man who developed a large left-sided hernia secondary to the minor trauma of a coughing fit. The hernia subsequently enlarged over the course of 3 years until it contained the stomach, leading to a gastric volvulus and tension gastrothorax with secondary pneumothorax. A subtotal gastrectomy was performed with Roux-en-Y reconstruction, and he made a full recovery. BACKGROUND
