Minimally invasive repair of congenital diaphragmatic hernia

Abstract

Purpose Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry (CDHR). Methods Prospectively collected data from CDH infants were analyzed from the CDHR from January 1995 to January 2010. Recurrent hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques. Results 5,480 infants with CDH were identified of which 4,516 (82.4%) were repaired. Operative data was available in 4,390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with twelve reported recurrences (7.9%) compared to one hundred fourteen for open techniques (2.7%, p < 0.05). MIS demonstrated a significant increased odds for recurrence (OR 3.59, 95% CI:1.92 – 6.71) after adjusting for gestational age, birth weight, patch repair, and ECMO. Conclusion Minimally invasive techniques appear to have a significant higher recurrent hernia rate with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regards to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization.

Congenital Diaphragmatic Hernia Survivors: Outcomes in Infancy, Childhood and Adolescence

“…Using data from the CDH Study Group, Tsao et al looked at the in-hospital hernia recurrence rate following MIS and found a significantly higher proportion of recurrence in the MIS group compared with open repair; the authors estimated an almost 4-fold increased odds of recurrence with MIS repairs. In this study, infants who required a patch repair had a higher recurrence rate, and MIS repairs that used a patch had the highest recurrence rate of approximately 9% (Tsao et al, 2011). The overall benefit for MIS in CDH patients remains to be determined.…”

Endosurgical treatment of diaphragmatic diseases in infants

“…Неко-торые авторы [32] определили, что торакоскопия со-провождалась достоверно меньшей продолжитель-ностью ИВЛ и сокращением пребывания больных в госпитале. Обнадеживающие данные получены в работе K. Tsao [9], который установил, что торако-ОРИГИНАЛЬНЫЕ СТАТЬИ скопическое лечение привело к лучшей выживаемо-сти младенцев (98,7% против 82,9%; p<0,05). Иссле-дование А.Ю.…”

“…В настоящее время торакоскопия постепенно вытесняет торакотомию в лечении врожденных и приобретенных заболеваний органов грудной клет-ки. Начиная с первых публикаций C. van Smith [1] о торакоскопической реконструкции эвисцерации диафрагмы у грудного ребенка в 1998 г. и N. Liem [2] о врожденной диафрагмальной грыже у ново-рожденных в 2003 г. количество сообщений о при-doi: 10.17116/endoskop201521525 -32 Эндохирургическое лечение заболеваний диафрагмы у новорожденных и детей грудного возраста менении видеоассистированного метода в этой воз-растной группе неуклонно растет [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…В частности, мультицентровое исследование, пред-ставленное K. Tsao [9] в 2011 г., продемонстриро-вало, что лапаротомия по-прежнему остается пред-почтительным действующим подходом (91,4%) для лечения аномалий диафрагмы. Хотя торакоскопия становится постепенно популярной техникой у мла-денцев с диафрагмальными дефектами, ее истинное воздействие на организм маленького ребенка оста-ется неопределенным.…”

Congenital Diaphragmatic Hernia: State of the Art Reconstruction- Biologics Versus Synthetics

“…Despite a case selection bias, there is already a significant incidence of recurrences in those repaired by MIS, as opposed to those undergoing an open repair, when examining 151 MIS repairs in the CDH registry out of a total of 4516 patients repaired (Tsao & Lally et al, 2011). Case selection was intended and evident in the disparate use of ECMO (Cho et al, 2009) and targeting groups with favorable criteria such as ventilator stability and absence of stomach or liver herniation (Yang et al, 2005;Kim et al, 2009).…”