Anterior Abdominal Wall Pseudohernias After Anatomic Lung Resection: Incidence and Risk Factors

TL;DR

This study found that pseudohernias can develop after lung surgery, especially with robotic techniques and cryoablation, and may affect patient recovery.

Contribution

The study identifies risk factors for pseudohernias after lung resection and suggests that robotic surgery and cryoablation increase their incidence.

Findings

Pseudohernias occurred in 7.6% of robotic surgery cases but not in thoracotomy cases.

Cryoablation at or below the seventh intercostal space was significantly correlated with pseudohernia development.

Patients with pseudohernias had higher acute and chronic pain scores and higher 30-day readmission rates.

Abstract

Thoracic surgery can damage intercostal nerves and cause muscular atrophy and bulging of the anterior abdominal wall (pseudohernia). This pilot study investigated the incidence of and risk factors for development of pseudohernias after anatomic lung resection in either robotic video-assisted thoracoscopic surgery (R-VATS) or thoracotomy cases.

A retrospective cohort analysis of 319 patients undergoing either R-VATS or thoracotomy for anatomic lung resection at a single institution from 2017 to 2021 was performed to determine pseudohernia incidence rates and possible risk factors.

Only patients who underwent R-VATS had pseudohernias, with an incidence rate of 7.6%. Readmission within 30 days of operation was higher in patients with pseudohernias (P = .02). Cryoablation at or below the seventh intercostal space was significantly correlated with pseudohernia development (P = .04). Diabetes trended toward increasing the risk for pseudohernias (P = .05). Acute and chronic pain scores were higher in patients with pseudohernias.

Robotic surgery and cryoablation are associated with an increased risk of pseudohernias, and the incidence may be higher than previous case reports suggest. Possible explanations are decreased tactile feedback, larger-diameter trocars, and lower intercostal access levels, leading to thoracoabdominal nerve damage. Understanding the incidence and risk factors for pseudohernias may inform surgical practices to improve patient outcomes and quality of life.

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