Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma

Our plain-English summary of Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma, by M. Egan, B.E. Louie, A.S. Farivar, et al (The Annals of Thoracic Surgery, 2012).

The study

• Authors: M. Egan, B.E. Louie, A.S. Farivar, O. Wagner, E. Vallières
• Journal: The Annals of Thoracic Surgery
• Published: 2012;93(5):e127-9
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Acute herniation of intra-abdominal organs into the chest after extrapleural pneumonectomy is an uncommon but morbid and potentially mortal complication. We report a case of acute diaphragmatic hernia after extrapleural pneumonectomy for mesothelioma repaired laparoscopically. This approach is an alternative to repeated thoracotomy and is a viable option for treatment of this difficult problem with potentially less morbidity.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This article was a case report from Swedish Medical Center and Cancer Institute in Seattle, Washington. It described one patient, a previously healthy 55-year-old man whose biopsies showed malignant pleural epithelioid mesothelioma on the left side. The article did not discuss asbestos exposure. He had a left extrapleural pneumonectomy, which removed the lung together with the left half of the diaphragm and of the heart lining, and the diaphragm was rebuilt with a synthetic patch. On the fifth day after surgery, an X-ray and a CT scan showed that part of his stomach had moved into the chest space left by the lung. Surgeons repaired this through small abdominal incisions (laparoscopy) instead of reopening the chest, and saw two areas where the diaphragm edge appeared torn, suggesting the stitches had pulled through. He went home 9 days after the first operation, and imaging at 18 months showed the repair intact. The authors concluded that laparoscopic repair is a viable option for this complication, possibly less harmful than reopening the chest. They noted it may be harder if little diaphragm muscle remains or the hernia is long-standing.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (a single patient)
• Who was studied: One previously healthy 55-year-old man treated at Swedish Medical Center and Cancer Institute, Seattle, Washington, diagnosed with malignant pleural epithelioid mesothelioma of the left pleura
• Exposure: The article does not describe any asbestos or other exposure. Its subject is a complication of surgery (left extrapleural pneumonectomy) for mesothelioma.
• Main results:
  • On the fifth day after the extrapleural pneumonectomy, the patient's chest X-ray showed an elevated gastric bubble.
  • CT with oral contrast showed that the patient's stomach had herniated into the pneumonectomy space.
  • At laparoscopy, the top part (fundus) of the stomach had herniated between the posterior diaphragm and the PTFE patch.
  • The diaphragm edge appeared torn in two areas, which suggested that the original sutures had pulled through.
  • The patient was discharged 9 days after the initial surgery.
  • At 18 months after surgery, imaging showed the repair still intact.
• The authors' conclusion: The authors concluded that laparoscopic repair of a diaphragmatic hernia after extrapleural pneumonectomy is a viable treatment option and may be a less morbid approach than reopening the chest.
• Limitations the authors state:
  • The authors noted that their initial decision not to close the diaphragm defect over the retroperitoneum may have contributed to the herniation.
  • The authors noted that if no diaphragm muscle remained, another structure such as a rib would be needed to anchor the mesh, making the operation more technically difficult.
  • The authors noted that a chronic (long-standing) hernia after extrapleural pneumonectomy would potentially be more difficult to repair by laparoscopy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Mesothelioma, Thoracotomy.

Related studies

• Laparoscopic thoracic duct clipping for persistent chylothorax after extrapleural pneumonectomy — N. Tsubokawa, Y. Hamai, et al. (2012)
• Acute postoperative cardiac herniation — K. Kawamukai, F. Antonacci, et al. (2011)
• Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch® — P. Zardo, R. Zhang, et al. (2011)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)
• A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma — S. Sonoda, Y. Kumagawa, et al. (2010)
• Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy's and St Thomas' hospitals — A. Bille, E. Belcher, et al. (2012)

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