Postoperative Residual Pleural Space: A Risk Factor for Chest Wall Hernia After Thoracoscopic Surgery

BACKGROUND Chest wall hernia and residual pleural space are known complications after thoracoscopic anatomical lung resection. Some risk factors for chest wall hernia have been described; however, residual pleural space has never been described as one of them. We present 2 cases suggesting that postoperative residual air space can represent a newly identified risk factor for chest wall hernia. CASE REPORT Case 1: A 71-year-old man developed a postoperative chest wall hernia at the fourth intercostal incision level 1 week after a 3-port thoracoscopic left lower lobectomy for early-stage non-small cell lung carcinoma. He was not known to have any described risk factors for postoperative chest wall hernia, but his postoperative course was complicated by a residual pleural space. Case 2: A 60-year-old man developed a postoperative chest wall hernia at the fourth intercostal incision level, diagnosed 5 months after a right apical upper lobe segmentectomy by 3-port thoracoscopy for early-stage non-small cell lung carcinoma. She was not known to have any risk factors for postoperative chest wall hernia; however, her postoperative course was also complicated by a residual pleural space. CONCLUSIONS We suggest that air flow through the thoracoscopic incision, due to residual pleural air, could impede wound healing and favor chest wall hernia. Adaptation of the closure technique for video-assisted thoracic surgery incisions in patients at risk may help prevent postoperative chest wall hernias. These cases highlight the possibility that residual pleural space could be a newly identified risk factor for postoperative chest wall hernia and propose potential preventive measures.