Uniportal VATS Mesh Insertion for Localized Lung Herniation

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This report details the surgical management of a post-traumatic intercostal muscle hernia in a 28-year-old male presenting with chronic symptoms following chest trauma one year prior. The patient's chief complaint was a chronic cough associated with a visible chest wall bulge that appeared when coughing or straining. 

Clinical Examination 

The clinical examination identified an area of chest wall weakness and bulging at the seventh intercostal space along the anterior axillary line. 

Superficial Ultrasonography 

Superficial ultrasonography confirmed the presence of a 10 mm intercostal muscle tear with a small underlying pleural bulge. 

Surgical Procedure: Uniportal VATS With Mesh Repair 

The patient underwent repair via a uniportal video-assisted thoracoscopic surgery (VATS) approach using a Prolene mesh for reinforcement. 

Preparation and Access 

The patient was placed in the left lateral decubitus position under general anesthesia and single-lung ventilation. The defect was marked pre-induction while the patient coughed to clearly delineate the site. A single incision was made for thoracoscope introduction. Under thoracoscopic guidance, the defect's exact location was confirmed using an external needle marker and simultaneous manual palpation. A double-layered Prolene mesh patch was tailored. Four small skin punctures were created around the defect for suture passage. The sutures were introduced externally, passed through the mesh corners, and retrieved internally to externally through the skin punctures, securing the mesh. The sutures were tied externally to ensure good fixation. Additional internal sutures were placed to eliminate mesh redundancy and prevent potential lung herniation. Final inspection confirmed satisfactory and stable mesh placement. An intercostal drain was inserted, and the incision sites were closed. 

Outcome 

This case demonstrates the efficacy of the uniportal VATS approach for the minimally invasive and secure repair of post-traumatic chest wall defect and lung herniation. 

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