Thoracoscopic Congenital Diaphragmatic Hernia repair in neonate: The First Experience of Iranian Group
Iranian Journal of Pediatric Surgery,
Vol. 1 No. 2 (2015),
24 February 2016
Background: Congenital diaphragmatic hernia (CDH) occurs due to a failure in closing pleuroperitoneal membrane thus resulting in an incomplete diaphragm formation1, which allows passage of the abdominal viscera into the thorax.1,3 Until 1995, the standard method for treatment of CDH was performed by open surgery through the abdomen or thoracic cavity. Minimally invasive approach via thoracoscopy or laparoscopy is applicable for treatment of CDH since 1995.4 Now a day’s thoracoscopic repair of CDH (T’Scopy CDH) is performed in many centers. In this paper, we present our experience of T’Scopy CDH repair from Iran.
Patients and Methods: From 2011 to 2015, 74 patients with CDH were admitted to Pediatric Surgery Department of Dr. Sheikh (Sarvar) Pediatric Hospital. Twenty one patients (28%) met our inclusion criteria and underwent T’Scopy CDH repair. The median age at the time of repair was 5 days (2-daysold to 4-years-old patients). Inclusion criteria were weight over 2 kg and stable hemodynamics and arterial blood gas. Fourteen cases were intubated before entering the operating room. The defect was in the left side except in two cases. In 8 cases, we used thoracic wall as part of repair. Also, mesh support was utilized in 8 cases even in cases were primary repair of diaphragm was possible in order to reinforcing the repair (5 cases). Of these 8 cases, in 3 patients, whole repair was accomplished by mesh due to presence of a large defect.
Results: The mean time of operation was 80 minutes (40-230 minutes). Intraoperative mortality was zero. In hospital, mortality occurred in two cases due to septicemia in one and respiratory and cardiac failure in another. Conversion to open surgery was required in 6 cases. Late recurrence was observed in 2 cases. The mean time of follow up was 14.6 months (3-36 months).
Conclusion: It seems that appropriate case selection and liberal use of thoracic wall and mesh as a part of repair may cause better results and decreased chance of early and late recurrence.
- congenital diaphragmatic hernia
- surgical repair
How to Cite
Chan E, Wayne C, Nasr A: Minimally invasive versus open repair of Bochdalek hernia: a meta-analysis. Journal of Pediatric Surgery. 2014; 49: 694-699.
Liem NT: Thoracoscopic approach in management of congenital diaphragmatic hernia. Pediatr Surg Int. 2013; 29: 1061-1064.
Tovar JA: Congenital diaphragmatic hernia. Orphanet Journal of Rare Diseases 2012; 7:1.
Tanaka T, Okazaki T, Fukatsu Y,et al: Surgical intervention for congenital diaphragmatic hernia: open versus thoracoscopic surgery. Pediatr Surg Int. 2013; 29: 1183-1186.
Becmeur F, Reinberg O, Dimitriu C, et al: Thoracoscopic repair of congenital diaphragmatic hernia in children. Seminars in Pediatric Surgery.2007; 16: 238-244.
Keijzer R, Ven CVD, Vlot J, et al: Thoracoscopic repair in congenital diaphragmatic hernia: patching is safe and reduces the recurrence rate. Journal of Pediatric Surgery. 2010; 45: 953-957.
Van der Zee DC, Bax NM: Laparoscopic repair of congenital diaphragmatic hernia in a 6-month-old child. Surg Endosc. 1995; 9:1001-3.
Davenport M, Rothenberg SS, Crabbe DCG, et al: The great debate: open or thoracoscopic repair for oesophageal atresia or diaphragmatic hernia. Journal of Pediatric Surgery. 2015; 50: 240-246.
Okazaki T, Nishimura K, Takahashi T, et al: Indication for thoracoscopic repair of congenital diaphragmatic hernia in neonates. Pediatr Surg Int. 2011; 27:35-38.
Chan E, Wayne C, Nasr A: Minimally invasive versus open repair of Bochdalek hernia: a meta-analysis. Journal of Pediatric Surgery. 2014; 49:694-699.
Nam SH, Cho MJ, Kim DY, et al: Shifting from laparotomy to thoracoscopic repair of congenital diaphragmatic hernia in neonates: early experience. World J Surg. 2013; 37:2711-2716.
Liem NT, Dung LA: Thoracoscopic repair for congenital diaphragmatic hernia: lessons from 45 cases. Journal of Pediatric Surgery. 2006; 41: 1713-1715.
Gupta RK, Parelkar SV, Oak SN, et al: Early experience with thoracoscopic repair of congenital diaphragmatic hernias in pediatric age group: results and lessons learned. Pediatr Surg Int. 2011; 27:563-566.
Tiryaki S, Bulut G, Erdenar HA, et al: High recurrence rate in thoracoscopic repair of Bochdalek type congenital diaphragmatic hernia. Turk Gogus Kalp Dama 2014; 22(3):596-600.
Cantone N, Destro F, Libri M, et al: Laparoscopic patch repair of recurrent anterior diaphragmatic hernia in a child with SMA. SpringerPlus 2014, 3:165.
Cho SD, Krishnaswami S, McKee JC, et al. Analysis of 29 consecutive thoracoscopic repair of congenital diaphragmatic hernia in neonates compared to historical control. J Pediatr Surg 2009;44:80-6.
Jancelewicz T, Vu LT, Keller RL, et al: Long-term surgical outcomes in congenital diaphragmatic hernia: observation from a single institution. J Pediatr Surg. 2010; 45:155-160.
McHoney M, Giacomello L, Nah SA, et al: Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilationand recurrence. Journal of Pediatric Surgery. 2010; 45: 355-359.
Liem NT. Thoracoscopic surgery for congenital diaphragmatic hernia: a report of nine cases. Asian Journal of Surgery. 2003; 26 (4):210-2.
Yang EY, Allmendinger N, Johnson SM, et al: Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome. Journal of Pediatric Surgery. 2005; 40: 1369-1375.
- Abstract Viewed: 365 times
- PDF Downloaded: 287 times