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Primary thoracoabdominal hernias

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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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Authors and Affiliations

  1. Department of Surgery, Division of Minima Access and Bariatric Surgery, Prisma Health Upstate, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA

    M. Alayon-Rosario, A. Hall, W. S. Cobb, J. A. Warren & A. M. Carbonell

  2. Carolinas Medical Center, Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    K. Schlosser, T. Griscom & V. Augenstein

  3. Department of Surgery, Division of Thoracic Oncology, Prisma Health Upstate, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA

    W. Bolton

  4. University of South Carolina School of Medicine, 701 Grove Rd, ST 3, Greenville, 29605, USA

    W. S. Cobb, J. A. Warren & A. M. Carbonell

Authors
  1. M. Alayon-Rosario
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  2. K. Schlosser
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  3. T. Griscom
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  4. W. Bolton
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  5. A. Hall
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  6. V. Augenstein
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  7. W. S. Cobb
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  8. J. A. Warren
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  9. A. M. Carbonell
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Corresponding author

Correspondence to J. A. Warren.

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Conflict of interest

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.

Research involving human participants and/or animals

This study did not involve animal research.

Informed consent

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

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