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Thoracoscopic repair of congenital diaphragmatic hernia in infancy
Oliver B Lao1, Matthew R Crouthamel, Adam B Goldin
1Department of Surgery, Seattle Children's Hospital, Seattle, Washington 98105, USA. olao@u.washington.edu
Insights
The thoracoscopic approach for congenital diaphragmatic hernia repair is feasible in 80% of infants. This minimally invasive technique shows comparable outcomes to open surgery, though further research is needed.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) repair outcomes vary with different surgical approaches.
- Minimally invasive thoracoscopic techniques are increasingly applied to CDH repair.
Purpose of the Study:
- To evaluate the successful completion rate of thoracoscopic CDH repair.
- To compare outcomes between open and thoracoscopic approaches for CDH repair.
Main Methods:
- Retrospective analysis of 31 infants undergoing CDH repair from February 2004 to January 2008.
- Patients were categorized into thoracoscopic and open surgical groups.
- Demographic, clinical, and hospitalization data were analyzed for outcome comparison.
Main Results:
- The thoracoscopic approach was successfully completed in 79% of cases.
- No significant differences were observed in sex, age, birthweight, pulmonary hypertension, or ICU/ventilator days between groups.
- Shorter operating room time was noted for the thoracoscopic group (70 min) compared to the open group (145 min).
- Gestational age was significantly higher in the open group (39 weeks) versus the thoracoscopic group (36.5 weeks).
Conclusions:
- Thoracoscopic repair of congenital diaphragmatic hernia is achievable in a majority of infants.
- Early experience suggests comparable hospitalization outcomes between thoracoscopic and open CDH repair.
- Larger studies are required to confirm differences in outcomes like length of stay and feeding initiation.
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.
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