Comparative analysis of radiological data of mediastinal pulmonary hernia in patients after anterior mediastinal mesh implant and extrapleural thoracoplasty with I–V ribs resection

• Tarasov R.V.
• Krasnikova E.V.
• Sadovnikova S.S.
• Veshkin A.A.
• Borisova V.V.
• Bagirov M.A.

Abstract

Aim. To compare the indicators of mediastinal pulmonary hernia after plastic surgery of the anterior mediastinum with a polymer mesh implant and extrapleural thoracoplasty with resection of the I–V ribs in patients who underwent pneumonectomy for tuberculosis according to X-ray research methods.

Material and methods. 49 patients were included in the study. Patients were divided into 2 groups: patients of the group 1 underwent anterior mediastinal plastic surgery with a mesh implant from the side of a single lung – 16 patients; patients of the group 2 underwent extrapleural thoracoplasty with resection of I–V ribs from the side of pneumonectomy – 33 patients. The size and volume of mediastinal pulmonary hernias were determined by comparing the data of computed tomography of the OGC before surgery and 3 months after surgery.

Results. After 3 months, it was found that the median total volume of a pulmonary hernia during anterior mediastinal plastic surgery with a mesh implant decreases by 57% (p<0.05), whereas after extrapleural thoracoplasty, it increases by 49% (p>0.05). At the same time, in group 1, the anterior pulmonary hernia decreased by 57% in 100% of cases, and the posterior hernia increased by 47% in 63% of cases. While in group 2, the anterior pulmonary hernia decreased by 47% in 30% of cases, and the posterior one decreased by 96% in 64% of cases.

Conclusion. Plastic surgery of the anterior mediastinum with a mesh implant prevents overgrowth of the lung tissue, does not deform the chest and shows statistically better results in terms of the size and volume of the anterior pulmonary hernia. On the contrary, extrapleural thoracoplasty with resection of the I–V ribs give the best result in terms of the size and volume of the posterior pulmonary hernia.

Keywords: mediastinal pulmonary hernia; polymer mesh implant; extrapleural thoracoplasty

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