Thoracoscopic Repair of Neonatal Diaphragmatic Hernia

Abstract

Neonatal MIS for CDH should be limited to stable patients. The ideal candidate is the newborn without associated anomalies, not requiring extracorporeal membrane oxygenation, on minimal ventilatory support, and without evidence of pulmonary hypertension. It is technically possible to perform thoracoscopic repair with a patch.

Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence

“…However, continued vigilance is needed to detect differences in the longer term. The recurrence rate of 25% after thoracoscopic repair seen in this series is comparable with that reported in the recent literature [17,18]. Possible explanations for higher recurrences during thoracoscopic approach include the acquiring of the learning curve for the procedure, the use of patch repair during thoracoscopy, and technical difficulties in achieving a complete diaphragmatic closure in these neonates.…”

Does thoracoscopic congenital diaphragmatic hernia repair cause a significant intraoperative acidosis when compared to an open abdominal approach?

“…Minimal access surgery is increasingly used in the pediatric and in the neonatal population [2][3][4][5][6][7][8][9][10][11][13][14][15]. In a recent series, Ponsky and Rothenberg [4] reported 649 minimal access operations performed in babies less than 5 kg in weight.…”

“…There is an emerging consensus that the most appropriate management of a Morgagni hernia using minimal access surgery is via a laparoscopic approach [5][6][7]. Despite early concerns about the use of thoracoscopy for minimal access Bochdalek congenital CDH repairs [8], there have been an increasing number of successful thoracoscopic CDH repairs reported in the literature [9][10][11][13][14][15]. Nguyen and Le [9] reported a series of 45 successful thoracoscopic CDH repairs in 2006, of which 19 were in newborns.…”

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

“…The potential advantages of the thoracoscopic approach include better surgical field visualisation, better wound cosmesis and the avoidance of thoracotomyassociated musculoskeletal deformities. Despite the growing interest in the field about this technique, only few series have been published in the literature, owing to the rarity of the disease [7][8][9][10][11][12][13][14]. In this study, we aim to review the experience of our two centres on surgical techniques and post-operative outcomes.…”