Abstract
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 Health–Upstate and Carolinas Medical Center. This includes all patients with spontaneous defects, excluding incisional hernias or those resulting from external trauma.
Results
Of 16 patients with thoracoabdominal hernias, 15 patients developed hernias after forceful coughing and one patient developed a hernia after strenuous physical activity. Seven patients required at least one additional intervention; two for recurrence; two for recurrence of original intercostal repairs done elsewhere; two for wound complications; and one had a missed abdominal wall component.
Conclusions
Primary thoracoabdominal hernias require a high index of suspicion. Durable repair involves complex reconstruction of the thoracoabdominal wall including the diaphragm, intercostal space, rib fracture fixation, and mesh reinforcement of the abdominal wall with permanent fixation constructs.
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Acknowledgements
Ashley Hall, BA: critical revision and editing of the manuscript.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Carbonell AM receives honoraria from W.L. Gore, Intuitive, and Ethicon. Warren JA receives honoraria from Intuitive, consulting fee from CMR Surgical. Cobb WS receives honararia from W.L. Gore and Ethicon. Augenstein V receives honoraria from Allergan. All remaining authors have no conflict of interest.
Ethics approval
No patient consent was required due the retrospective nature of the study and minimal patient risk as approved by the Prisma Health and Carolinas Medical Center Institutional Review Boards.
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This study did not involve animal research.
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Informed consent was not required in this study.
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Alayon-Rosario, M., Schlosser, K., Griscom, T. et al. Primary thoracoabdominal hernias. Hernia 25, 1621–1628 (2021). https://doi.org/10.1007/s10029-020-02194-7
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DOI: https://doi.org/10.1007/s10029-020-02194-7