Thoracoabdominal hernias after chest wall resection, prevention methods
Abstract
Introduction. The formation of thoracoabdominal hernia (TAH) after the chest wall resection is described in a single publication of foreign literature. The reasons for the formation of TAH, the development and surgical methods of prevention remain unstudied.
Materials and methods. In N.N. Blokhin Center of Oncology from 2000 till 2019, there had been 258 surgical interventions performed on primary and metastatic tumors. These were resections of one or several ribs, or sternum with simultaneous reconstruction with local or displaced tissues, in some cases, using various allogenic materials. TAH was detected in 48 cases. The results. The key risk factors for hernia formation were: resection of the VII rib and below, lack of reconstruction of the costal arch, defect of the chest wall with the surface of 50 cm2 or more.
Reconstruction with local tissues or a displaced flap is able to prevent the formation of TAH only in the cases of defect of the chest wall with the surface within 60 cm2, with the use of a GorTex Dual mash® plate, with a defect of up to 70 cm2, and with the use of rigid reconstruction methods, up to 145 cm2.
Conclusions. The most obvious reason for the formation of TAH, is the intra-abdominal pressure on the area of the chest wall defect.
The surgeon should consider these risk factors and bear in mind the need for additional reconstruction of the chest wall to prevent the formation of TAH.
About the Authors
E. P. Mezhetsky
N.N. Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
24, Kashirskoe Shosse, Moscow, 115478.
V. A. Sobolevsky
N.N. Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
24, Kashirskoe Shosse, Moscow, 115478.
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Review
For citations:
Mezhetsky E.P., Sobolevsky V.A. Thoracoabdominal hernias after chest wall resection, prevention methods. Bone and soft tissue sarcomas, tumors of the skin. 2019;11(4):25-30. (In Russ.)
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