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Objective: Omitting pleural drainage after video-assisted thoracic surgery (VATS) for pulmonary wedge resections has been shown to be a safe approach to enhance recovery. However, major concerns remain regarding the risk of postoperative pneumothoraces requiring surgical interventions. Therefore, our objective was to provide conclusive evidence whether chest tube omission after VATS wedge resection is safe and does not increase the risk of pneumothoraces requiring pleural drainage., Methods: Five scientific databases were searched. Studies comparing patients with (CT group) and without chest tube drainage (NCT group) after VATS wedge resection were evaluated. Outcomes included radiographically diagnosed pneumothoraces and pneumothoraces requiring pleural drainage, postoperative complications, hospitalization, and pain scores., Results: Overall, 9 studies (3 randomized controlled trials) were included ( N  = 928). Meta-analysis showed significantly more radiographically diagnosed pneumothoraces in the NCT group (risk ratio [RR] = 2.58, 95% confidence interval [CI]: 1.56 to 4.29, P  < 0.001; I 2  = 0%). However, no significant differences were found in postoperative pneumothoraces requiring pleural drainage (RR = 1.72, 95% CI: 0.63 to 4.74, P  = 0.29; I 2   = 0%) or complications (RR = 0.77, 95% CI: 0.39 to 1.52, P  = 0.46; I 2  = 0%). Furthermore, the NCT group showed significantly shorter hospitalization (mean difference = -1.26, 95% CI: -1.56 to -0.95, P  < 0.001) with high heterogeneity ( I 2  = 58%, P  = 0.02), and lower pain scores on postoperative day 1 (standard mean difference [SMD] = -0.98, 95% CI: -1.71 to -0.25, P  = 0.009; I 2  = 92%) and postoperative day 2 (SMD = -1.28, 95% CI: -2.55 to -0.01, P  = 0.05; I 2  = 96%) compared with the CT group., Conclusions: VATS wedge resection without routine chest tube placement is suggested as a safe and less invasive approach in selected patients that does not increase the risk of a pneumothorax requiring pleural drainage.

Costochondral separation is a rare phenomenon following blunt thoracic trauma that can also be associated with secondary injuries. We present a case with complete costochondral separation of the right second rib with concomitant mediastinal compression. Definitive treatment was provided through video-assisted thoracoscopic surgical plate osteosynthesis.

During repair of pectus excavatum by the modified Ravitch procedure, the major pectoral muscles are detached from their sternal insertion to obtain adequate surgical exposure. Following repair, the muscles are approximated in midline and reinserted through scarring. Dehiscence of the major pectoral muscles after the modified Ravitch procedure is a rare phenomenon, not previously reported in literature. We report on 2 cases and describe an effective treatment method using sternal suture anchors with good long-term results.

Objective: Primary benign cardiac tumors are rare disease entity that predominantly originate from the atria. Benign masses can induce heart failure, arrhythmia, or thromboembolic events. Therefore, surgical excision is often indicated. Current guidelines on the preferred approaches for resection (i.e., median sternotomy [MST] or right anterolateral thoracotomy [RAT]) are lacking. The aim of the current meta-analysis was to evaluate all studies comparing RAT to MST for excision of benign atrial masses in terms of safety, efficacy, and complications., Methods: The PubMed and EMBASE databases were searched through 9 June 2020. Data regarding mortality, complications, recurrence, ICU stay, and length of hospital stay were extracted and submitted to meta-analysis using random effects modelling. Heterogeneity was assessed by the I 2 test., Results: Four retrospective observational studies were included, including 196 patients (RAT n = 97, MST n = 99). Mortality was 0% in both groups. Recurrence was <1% in the RAT group and 0% in the MST group. Complication rate tended to be lower in favor of the RAT group. Furthermore, RAT was associated with lower length of ICU stay (-17.7 hr, P = 0.01) and hospital stay (-4.0 days, P < 0.001). No significant differences in cardiopulmonary bypass ( P = 0.09) and cross-clamp times ( P = 0.15) were observed., Conclusions: The RAT approach is as safe and effective as MST for the excision of benign atrial masses. Moreover, RAT is associated with a reduced complication rate and a reduced duration of hospitalization and could be considered as the preferred approach in anatomically suitable patients.

Purpose: To describe the durability of endovascular aortic occlusion as an alternative treatment of an aortoenteric fistula in a severely unstable patient., Case Report: A 47-year-old patient with a history of numerous previous vascular reconstructions underwent surgical exclusion of a persistent aorto-enterocutaneous fistula originating from a former colostomy site in proximity with the occluded left leg of an aortobifemoral bypass. Nine weeks later, he presented in profound hypovolemic shock from bleeding via the cutaneous remnant of the fistula and gastrointestinal tract. Because of the severe shock, recent surgery, and lack of a suitable endograft for the small-caliber aorta (19 mm), endovascular exclusion of the fistula was undertaken by occluding the infrarenal aorta. Talent occluders were also placed in the right femoral bypass limb and the right common iliac artery. An extra-anatomical bypass was created to revascularize the lower extremities. The patient was discharged in good condition on day 20. The fistula spontaneously regressed after 12 months. Since the patient refused further surgery, 44-month follow-up is now available. There are no signs of reinfection or recurrent aortoenteric fistula., Conclusion: Endovascular occlusion of a small caliber aorta with extra-anatomical revascularization of the lower extremities may be considered a useful treatment alternative for an aortoenteric fistula in severely unstable or compromised patients, either as a bridge to open surgery or as a definitive treatment if signs of reinfection do not occur.