The evolution of a novel technique for treatment of intercostal hernias and restoration of costal margin rupture.

Abstract

Costal Margin Rupture (CMR), with or without Intercostal Hernia (IH), is often a missed diagnosis. This has led to recent recommendations for a comprehensive and standardised classification, aiming to generate a heightened index of suspicion for these injuries. [1] While some surgical techniques have been published, surgical failure rates remain high and optimal surgical management remains undefined. We present three patients with IH, where the diagnosis of CMR played a pivotal role in the surgical management. In the first case, the CMR was identified post-operatively after a first surgical attempt to treat the IH had failed. In contrast, increased clinical suspicion in the second and third cases led to early diagnosis of the CMR. All three patients underwent a successful repair of the CMR using an innovative technique with a titanium bar crimped to rotatable connectors mounted on titanium rib clips. These cases highlight the importance of early recognition and comprehensive imaging and digital reconstruction techniques in detecting CMR. The surgical technique might be a useful addition to the surgical armamentarium/repertoire of the chest wall surgeon.