Congenital Diaphragmatic Hernia: Experience and Results of Thoracoscopic Repair from a Tertiary Care Hospital
Introduction Congenital diaphragmatic hernia (CDH) is one of the most common congenital anomalies encountered by pediatric surgeons. With the advances in the pediatric minimal access surgery, its role in the repair of CDH has also increased. We have been using thoracoscopy for the repair for CDH since 2015. We herein report our experience of CDH repair in newborns.
Materials and Methods A retrospective review was conducted from July 2015 to December 2019 in the Department of Pediatric surgery after ethical approval from the institutional review board and included all the children with CDH who underwent thoracoscopic repair. The case records were used to assess the demographic details, type of defect, and early and late postoperative complications of thoracoscopy in CDH.
Results Thoracoscopic repair was attempted in 29 patients of CDH. Eight (27.5%) patients converted to open procedure and were excluded from the study. Primary closure of the diaphragmatic defect was performed in 90.4% (19) patients. Also, 9.5% (2) children required mesh repair. There was no intraoperative death. Postoperative ventilation was required in 57.1% (12) children. The mean time on the ventilator was 3.03 ± 0.9 days. The mean age of children requiring postoperative ventilation was less compared with children who were extubated in the postoperative period (p = 0.032). The median follow-up in our study was 12 months and 28.5% of patients developed recurrence of the diaphragmatic hernia. All the children underwent laparotomy and repair of the diaphragmatic defect.
Conclusion Thoracoscopic repair is a safe and effective option for the repair of CDH in children performed by surgeons with significant procedure experience.
15 July 2020 (online)
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- 1 Smith NP, Jesudason EC, Featherstone NC, Corbett HJ, Losty PD. Recent advances in congenital diaphragmatic hernia. Arch Dis Child 2005; 90 (04) 426-428
- 2 Friedmacher F, Pakarinen MP, Rintala RJ. Congenital diaphragmatic hernia: a scientometric analysis of the global research activity and collaborative networks. Pediatr Surg Int 2018; 34 (09) 907-917
- 3 Leeuwen L, Fitzgerald DA. Congenital diaphragmatic hernia. J Paediatr Child Health 2014; 50 (09) 667-673
- 4 Tyson AF, Sola Jr R, Arnold MR, Cosper GH, Schulman AM. Thoracoscopic versus open congenital diaphragmatic hernia repair: single tertiary center review. J Laparoendosc Adv Surg Tech A 2017; 27 (11) 1209-1216
- 5 Jain V, Agarwala S, Bhatnagar V. Recent advances in the management of congenital diaphragmatic hernia. Indian J Pediatr 2010; 77 (06) 673-678
- 6 Gomes Ferreira C, Reinberg O, Becmeur F. et al. Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy. Surg Endosc 2009; 23 (07) 1650-1659
- 7 Barroso C, Correia-Pinto J. Thoracoscopic repair of congenital diaphragmatic hernia: review of the results. Minerva Pediatr 2018; 70 (03) 281-288
- 8 Becmeur F, Jamali RR, Moog R. et al. Thoracoscopic treatment for delayed presentation of congenital diaphragmatic hernia in the infant. A report of three cases. Surg Endosc 2001; 15 (10) 1163-1166
- 9 Lao OB, Crouthamel MR, Goldin AB, Sawin RS, Waldhausen JHT, Kim SS. Thoracoscopic repair of congenital diaphragmatic hernia in infancy. J Laparoendosc Adv Surg Tech A 2010; 20 (03) 271-276
- 10 Liem NT. Thoracoscopic approach in management of congenital diaphragmatic hernia. Pediatr Surg Int 2013; 29 (10) 1061-1064
- 11 Okazaki T, Okawada M, Ishii J. et al. Intraoperative ventilation during thoracoscopic repair of neonatal congenital diaphragmatic hernia. Pediatr Surg Int 2017; 33 (10) 1097-1101
- 12 Huang JS, Lau CT, Wong WYY, Tao Q, Wong KK, Tam PKH. Thoracoscopic repair of congenital diaphragmatic hernia: two centres’ experience with 60 patients. Pediatr Surg Int 2015; 31 (02) 191-195
- 13 Schneider A, Becmeur F. Pediatric thoracoscopic repair of congenital diaphragmatic hernias. J Vis Surg 2018; 4: 43
- 14 Tsao K, Lally PA, Lally KP. Congenital Diaphragmatic Hernia Study Group. Minimally invasive repair of congenital diaphragmatic hernia. J Pediatr Surg 2011; 46 (06) 1158-1164
- 15 von Renteln D, Vassiliou MC, Rösch T, Rothstein RI. Triangulation: the holy grail of endoscopic surgery?. Surg Endosc 2011; 25 (05) 1355-1357
- 16 Shah SR, Wishnew J, Barsness K. et al. Minimally invasive congenital diaphragmatic hernia repair: a 7-year review of one institution’s experience. Surg Endosc 2009; 23 (06) 1265-1271
- 17 He Q, Zhong W, Wang Z, Yan B, Xie X, Yu J. Simple and safe thoracoscopic repair of neonatal congenital diaphragmatic hernia by a new modified knot-tying technique. Hernia 2019; 23 (06) 1275-1278
- 18 Fujishiro J, Ishimaru T, Sugiyama M. et al. Minimally invasive surgery for diaphragmatic diseases in neonates and infants. Surg Today 2016; 46 (07) 757-763
- 19 Vijfhuize S, Deden AC, Costerus SA, Sloots CEJ, Wijnen RMH. Minimal access surgery for repair of congenital diaphragmatic hernia: is it advantageous?–An open review. Eur J Pediatr Surg 2012; 22 (05) 364-373