Thoracoscopic repair of congenital diaphragmatic hernia: two centres’ experience with 60 patients

Huang, Jinshi; Lau, Chak‐Sing; WONG, WAI-SANG; Tang, Qiang; Wong, Kenneth K. Y.; Tam, Paul Kwong Hang

doi:10.1007/s00383-014-3645-0

Cited by 20 publications

(5 citation statements)

References 23 publications

(29 reference statements)

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“…9,10 On the contrary to these findings, other studies did not reveal any advantage of the thoracoscopic approach. Further, this was associate with an increased rate of recurrence 11,12 with persisting concern about hypercapnia and acidosis. 13 Most of the evidence available is in the form of small retrospective.…”

Section: Discussionmentioning

confidence: 97%

Congenital Diaphragmatic Hernia: Experience and Results of Thoracoscopic Repair from a Tertiary Care Hospital

Pandey

Gopal

2020

Annals of the National Academy of Medical Sciences (India)

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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.

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Section: Discussionmentioning

confidence: 97%

Congenital Diaphragmatic Hernia: Experience and Results of Thoracoscopic Repair from a Tertiary Care Hospital

Pandey

Gopal

2020

Annals of the National Academy of Medical Sciences (India)

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“…Meanwhile, the thoracoscopic repair was found to be associated with shorter ventilation time, earlier return to full enteral feeds, shorter hospital stay, improved cosmesis and decreased cost compared to the open repair. [ 14 15 16 ] However, the high recurrent rate remains a concern after thoracoscopic repair. [ 17 ] In this study, we found that neonates who had thoracoscopic repair had shorter ventilation time and earlier reestablishment of enteral feeding compared to the open approach; however, hospital stay was not significantly different between groups despite lower in thoracoscopic repair.…”

Section: Discussionmentioning

confidence: 99%

Congenital diaphragmatic hernia in neonates: Open versus thoracoscopic repair

Bawazir

2021

Afr J Paediatr Surg

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Background: There are no standard criteria to select patients for thoracoscopic repair of congenital diaphragmatic hernia (CDH). The objective of this study was to compare open laparotomy versus thoracoscopic repair of CDH in neonates. Patients and Methods: This retrospective study included 41 patients who had repair of CDH from 2011 to 2019. Patients were divided into two groups according to the surgical approach; open laparotomy ( n = 30) and thoracoscopic repair ( n = 11). Study endpoints were duration of post-operative mechanical ventilation, hospital stay and the return to full enteral feeding. Results: Patients who had thoracoscopic repair were significantly younger (3 [25 th - 75 th percentiles: 3-3] vs. 4 [3–5] days; P = 0.004). Other pre-operative variables were comparable between both groups. The duration of surgery was significantly longer in the thoracoscopic repair (174 [153–186] vs. 91 (84–99) min; P < 0.001). The use of pre-operative nitrous oxide inhalation was associated with prolonged ventilation ( P = 0.004), while the thoracoscopic repair was associated with shorter mechanical ventilation ( P = 0.006). Hospital stay is lower in the thoracoscopic approach but did not reach a significant value ( P = 0.059). The use of pre-operative nitrous oxide was associated with a prolonged hospital stay ( P = 0.002). Younger age (HR: 1.33, P = 0.014) and open approach (HR: 3.56, P = 0.004) were significantly associated with delayed feeding. Conclusions: The thoracoscopic approach is safe and effective for repairing the CDH. It is associated with shorter mechanical ventilation and rapid return to enteral feeding. Proper patient selection is essential to achieve good outcomes.

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“…Previously, thoracoscopic or laparoscopic approaches were used, but now the minimally invasive surgical techniques are preferred. The latter appear to be burdened by a higher percentage of relapses which, however, are reduced if carried out by an expert team and if a prolonged monitoring of the patient is carried out [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

A Recurrent Abdominal Pain with Chronic Constipation

Malcotti¹,

Scintu²,

Nieri³

et al. 2019

Arch Pediatr Surg

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We here report the case of a 5-years-old child with recurrent abdominal pain and chronic constipation. For that reason, the baby came to our hospital several times with symptoms' resolution after enema. Despite the medical therapy and the instrumental approaches, the situation of the last admission proceeded to intestinal obstruction and therefore to specialistic surgery in emergency during the night, with resolution of the obstruction that was due to a congenital malformation that was gone undiagnosed during pregnancy, at birth and during the previous admissions. Such anomaly is rarely diagnosed after the neonatal period, anyway the present case underlines that this condition must be taken into account in every patient with recurrent abdominal pain and constipation episodes.

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Thoracoscopic repair of congenital diaphragmatic hernia: two centres’ experience with 60 patients

Abstract: Thoracoscopic repair of congenital diaphragmatic hernia can be performed safely in specialised centres. The post-operative recovery and cosmesis are excellent. Diaphragmatic hernia with large defect remains a challenge for surgeons.

Cited by 20 publications

References 23 publications

Congenital Diaphragmatic Hernia: Experience and Results of Thoracoscopic Repair from a Tertiary Care Hospital

Congenital Diaphragmatic Hernia: Experience and Results of Thoracoscopic Repair from a Tertiary Care Hospital

Congenital diaphragmatic hernia in neonates: Open versus thoracoscopic repair

A Recurrent Abdominal Pain with Chronic Constipation

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