Contralateral anterial mediastinal plasty with a polymer mesh implant - a new method of surgery for post-pneumonectomy mediastinal hernia in patients with widespread tuberculosis

Abstract

After pneumonectomies for widespread pulmonary MDR tuberculosis a mediastinal hernia is formed in 30-80% of patients, what leads to overextension of the only lung tissue, and to displacement of mediastinal organs to the opposite hemothorax. As a result, many patients after surgery have reduced exercise tolerance due to violations of ventilation, gas exchange, cardiovascular disorders as well as progression of TB in the remaining foci.

Our aim is to demonstrate a new surgical method for post-pneumonectomy anterior mediastinal hernias using a polymer mesh implant performed contralateral.

Materials and Methods: The surgical approarch was performed from the side of the only lung. The replaced lung tissue was returned into its own hemithorax, then non-absorbable polymer mesh implant was sutured above the hernia gate, what prevented subsequent lung herniation into the opposite hemithorax.

We examined 9 patients with widespread MDR TB who had pneumonectomy mediastinal hernias. We compared X-ray and functional parameters of the preoperative and postoperative periods.

Results: All patients showed a decrease of dyspnea. X-ray examinations showed a stable elimination of anterior mediastinal hernia. The respiratory indicators FVC and FEV1 in 88% of cases showed the same level as before surgery, the ratio of FEV1/FVC increased in 100% of cases, what indicated a decrease of obstruction.

Conclusion: the technique of contralateral anterial mediastinal plasty with a polymer mesh implant permits to resolve the hernia, improves functional indicators and prevents the progression of tuberculosis in the remaining foci.