Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Infancy

Abstract

Background Minimally invasive surgical techniques, specifically the thoracoscopic approach, have been applied to congenital diaphragmatic hernia (CDH) with varying outcomes from selected centers. The aim of our study was to examine the rate of successful completion and compare outcomes between open and thoracoscopic approaches in CDH repair. Methods We performed a retrospective analysis of infants with CDH repair (From February 2004 to January 2008). Patients were divided into thoracoscopic and open groups, based on operative approach. We analyzed demographic, clinical, and hospitalization characteristics to compare the completion rate and outcomes in these two groups. Results Analysis of 31 infants with CDH (14 thorascocopic and 17 open) demonstrated no differences in sex (P = 0.132), age (P = 0.807), birthweight (P = 0.256), weight at operation (P = 0.647), pulmonary hypertension (P = 0.067), preoperative intensive care unit (ICU) days (P = 0.673), ventilator days (P = 0.944), or use of a patch (P = 0.999) between the groups. Seventy-nine percent of thoracoscopic operative approaches were completed successfully. There was a significant difference between the open and thoracoscopic groups with respect to estimated gestational age (39 versus 36.5 weeks; P = 0.006) and operating room time (70 versus 145 minutes; P = 0.004). The total (P = 0.662), ICU (P = 0.889), and postoperative (P = 0.619) length of stay and days on ventilator (P = 0.705), as well as days until initial enteral feeds (P = 0.092), were not significantly different between groups. There were no deaths and no evidence of recurrence, with a mean follow-up of 346 days. Conclusions In our early experience, the thoracoscopic approach for congenital diaphragmatic hernia repair was completed in 80% of our patient population with minimal exclusion criteria. Further study, with larger sample sizes, is needed to ascertain differences in outcomes, such as length of stay and initiation of enteral feeding.

Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study

“…This has been demonstrated in other series as well [5]. The number of patients requiring high-frequency ventilation or the oscillator postoperatively was similar in both groups.…”

“…Despite these perceived advantages, one of the most important outcomes for a CDH is a secure, long-lasting repair. Although not reaching statistical significance, there has been a reported higher recurrent hernia rate after thoracoscopic CDH repair seen in other institutional reports [1–5,7,8]. Recently, a meta-analysis reported a statistically higher recurrence rate in the thoracoscopic repair group [12].…”

“…However, efficacy has not yet been proven. For thoracoscopic CDH repair, recurrent hernia has been reported to be between 0% and 25%, with most authors noting it to be higher than 15% [1–5,7,8]. Although no single-institution, published report has noted the recurrence rate to be statistically significant, the incidence is higher than the 10% recurrence rate after open repair that was reported in the largest series published to date [9].…”

Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis

“…Early recovery from surgical stresses often reduces the duration of postoperative mechanical ventilation and the overall length of stay [15]. Furthermore, the longitudinal incidences of subsequent scoliosis and chest deformity may also be reduced [18,22]. On the other hand, ES was clearly associated with a higher recurrence rate than OS in our study.…”

Congenital diaphragmatic hernia

“…Certainly, hypercarbia and acidosis are almost invariable using carbon dioxide insufflation. Nevertheless, recent reports have shown the feasibility and safety of this approach even in unselected groups of patients [78][79][80]. It also seems that, in contrast to the open technique, where the abdominal approach is standard, thoracoscopic repair is somewhat easier.…”