Thoracoscopic repair of diaphragmatic eventration in children: a comparison of two repair techniques

Bawazir, Osama A.; Banaja, Abdulaziz M

doi:10.1016/j.jpedsurg.2019.11.019

Cited by 3 publications

(6 citation statements)

References 15 publications

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“…Overall outcomes were satisfactory with 88.3% of immediate resolution of symptoms and 90% of diaphragmatic level improvement on chest radiographs. On the whole, most series describe prompt and durable improvement or resolution of symptoms after surgery in 91 to 100% of the cases [2,4,6,7,10], with 0 to 7% of incomplete repair or eventration recurrence [10,15,16], which is comparable to our 7.1% recurrence rate. Seven out of the eight recurrences of diaphragmatic eventration occurred following thoracoscopy.…”

Section: Discussionsupporting

confidence: 82%

“…Very few studies have addressed this topic. Bawazir et al [10] compared interruptive sutures and the pleated technique in video-assisted thoracoscopy while Le Pimpec et al [1] reported the flag plication as gold standard for thoracoscopy, with a similar conclusion to ours. No study has, however, specifically examined the usefulness of absorbable or permanent materials.…”

Section: Discussionsupporting

confidence: 77%

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Retrospective cohort analysis of surgical management for congenital diaphragmatic eventration in children

Alzahrani,

Heng,

Khen-Dunlop

et al. 2024

Preprint

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Background: Diaphragmatic plication is the most widely used surgical approach for treating congenital diaphragmatic eventration (CDE) in children. This study aims to assess current surgical practice for this pathology in children. Methods: Retrospective data analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021. Comparative description of the different surgical approaches and their outcomes, including robot-assisted thoracoscopic surgery (RATS). (Clinical TrialsNCT04862494). Results: 112 patients, aged 12 [5 - 21] months, were operated on for CDE. Diaphragmatic plication was performed using thoracoscopy or RATS in 69 (62%) cases, postero-lateral thoracotomy (PLT) in 15 (13%), and using an abdominal approach in 28 (25%). Relief of symptoms and improvement in the diaphragmatic level on chest radiographs were obtained in 88% and 90% of the cases, respectively. We recorded 32 peri- or early postoperative complications (29%) and eight recurrences of eventration (7%), but found no correlation between these complications and the surgical approach used. Compared to other approaches, PLT multiplied the duration of intravenous analgesia by three (96 vs 36h, p<0.0001), and the length of hospital stay by two (8 vs 4d, p = 0.002). Compared to thoracoscopy, RATS provided more perioperative hepatic injuries and equivalent short-term results, but all five patients remained symptomatic and two of them experienced chest wall deformities in long-term follow-up. Conclusions: Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. RATS emerges as a promising surgical approach, but further is required to confirm that it is, at least, not inferior to thoracoscopy.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 77%

Retrospective cohort analysis of surgical management for congenital diaphragmatic eventration in children

Alzahrani,

Heng,

Khen-Dunlop

et al. 2024

Preprint

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“…With more than 2 years of follow-up, 79% of the patients appeared to be clinically resolved, whatever their treatment option, while chest radiographs showed twice the improvement of the diaphragmatic level after surgery than with conservative management (44.4% vs 89.6%, OR = 11.5). On the whole, most series describe prompt and durable improvement or resolution of symptoms after surgery in 91 to 100% of the cases [4, 5, 7, 10, 14], with 0 to 7% of incomplete repair or eventration recurrence [14, 16, 17], which is comparable to our 7.1% recurrence rate. Another explanation for recurrence could be the difficulty to sometimes differentiate CDE from congenital diaphragmatic hernia with a hernia sac, even during surgery, the treatment of which consists of the resection of the sac and hernia repair rather than diaphragmatic plication [18].…”

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

“…No functional imaging, such as diaphragm fluoroscopy or dynamic US or MRI, was reported in this series. Indeed, in showing the paradoxical motion of the diaphragm and its potential repercussion on lung expansion [13,14], these exams may improve surgical indication and efficiency, but these hypotheses remain to be tested. Surgical treatment has long been indicated for symptomatic patients [6,9], and conservative management for asymptomatic or paucisymptomatic patients [15], even though some authors once advocated for systematic diaphragmatic plication to prevent lung growth restriction in neonates [4].…”

Section: Discussionmentioning

confidence: 99%

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Congenital diaphragmatic eventration: Should we maintain surgical treatment? A retrospective multicentric cohort study

Heng,

Alzahrani,

Khen-Dunlop

et al. 2024

Preprint

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Background: Congenital diaphragmatic eventration (CDE) is an infrequent congenital pathology without consensus of treatment. This study assessed current care practices for this pathology in children in France. Methods: Retrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age followed for CDE since 2010. Patients with surgical or conservative treatment were compared. Results: 139 patients were included, with a median age of 8 [1 to 16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. It was symptomatic in 65% of the cases, with a respiratory component for 97% of these patients. The primary indication for treatment, essentially depending on the clinical respiratory impairment and the level of the diaphragm, was surgery for diaphragmatic plication in 87 cases (62%) or clinical follow-up for the 52 others, 25 of whom were operated on secondarily. There were 32 early per- or postoperative complications (29%), and 8 recurrences of eventration (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome fell from the 6th to the 9th back rib, and the rate of respiratory symptoms from 64% to 14%, in both surveyed and surgically treated patients. Conclusions: CDE is mainly diagnosed in newborn or infant boys and right-sided. Diaphragmatic plication may be the best treatment in symptomatic patients with a dome level upper the 6th posterior rib, but exposes them to a 29% complication rate and 7% of recurrence. ClinicalTrialsNCT04862494, April 28, 2021.

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Robot-assisted thoracoscopic versus conventional thoracoscopic plication for diaphragmatic eventration in children: Comparison of mid-term outcomes

Zhang,

Tang,

Liu

et al. 2024

Journal of Pediatric Surgery Open

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Thoracoscopic repair of diaphragmatic eventration in children: a comparison of two repair techniques

Cited by 3 publications

References 15 publications

Retrospective cohort analysis of surgical management for congenital diaphragmatic eventration in children

Retrospective cohort analysis of surgical management for congenital diaphragmatic eventration in children

Congenital diaphragmatic eventration: Should we maintain surgical treatment? A retrospective multicentric cohort study

Robot-assisted thoracoscopic versus conventional thoracoscopic plication for diaphragmatic eventration in children: Comparison of mid-term outcomes

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