Abstract
Although improvements have been made, the management of congenital diaphragmatic hernia
(CDH) remains a major challenge for perinatologists and neonatal surgeons. Many aspects
of the disease remain unknown and, being a rare entity, evidence-based data are hard
to find. Surgical morbidity is considerable and affects long-term quality of life.
Perioperative complications have been reviewed focusing on thoracoscopic repair. Intraoperative
acidosis was more severe during thoracoscopy when compared with open surgery (OS),
though it is possible that later neurodevelopment was not affected. Even so, strategies
have been outlined to reduce acidosis, such as decreasing carbon dioxide (CO2) insufflation after reduction of the herniated viscera into the abdomen is complete.
The risk of pleural complications decreased after introduction of gentle ventilation
techniques and minimally invasive surgery (MIS); thus, the use of a prophylactic intraoperative
thoracic tube is not routinely required. Recurrence rate was higher in large CDH and
following MIS repair. Technical demands play an important role, therefore, in avoiding
complications; every step of the OS technique must be strictly accomplished. In large
defects, the use of prosthetic patch might reduce recurrence rate, even by MIS repair,
once again only if technical demands are overcome with meticulous rules of suturing.
Thoracoscopy significantly reduced the incidence of bowel obstruction and recovery
time and improved cosmesis. The best approach of CDH is yet to be found, and it goes
far beyond the management of perioperative complications. Meanwhile randomized controlled
studies, namely on the outcome of thoracoscopic repair, are required to inform further
practice.
Keywords
congenital diaphragmatic hernia - perioperative complications - thoracoscopic repair
- minimally invasive surgery
