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Minimally invasive repair of congenital diaphragmatic hernia
KuoJen Tsao1, Pamela A Lally, Kevin P Lally
1Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, Houston, TX 77030, USA. kuojen.tsao@uth.tmc.edu
Insights
Minimally invasive surgery for congenital diaphragmatic hernia (CDH) repair in infants shows a higher short-term recurrence rate compared to open techniques. Thoracoscopy had the highest recurrence rate in this study.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) repair approaches vary across institutions.
- The short-term recurrence rate following minimally invasive surgery (MIS) for CDH is not well-documented.
Purpose of the Study:
- To evaluate the in-hospital recurrence rate of MIS repairs in infants with CDH.
- To compare recurrence rates between MIS and open repair techniques for CDH.
Main Methods:
- Analysis of prospectively collected data from the Congenital Diaphragmatic Hernia Registry (1995-2010).
- Inclusion of infants with CDH who underwent operative repair (abdominal, thoracic, laparoscopic, thoracoscopic).
- Recurrent hernia defined as reoperations during the initial hospitalization.
Main Results:
- Of 4516 repaired CDH cases, 151 (3.4%) underwent MIS repair.
- MIS repairs had a significantly higher recurrence rate (7.9%) compared to open repairs (2.7%, P < .05).
- MIS demonstrated increased odds for recurrence (OR 3.59) after adjusting for key covariates.
Conclusions:
- Minimally invasive techniques for CDH repair are associated with a higher short-term recurrence rate.
- Thoracoscopic repair showed the highest recurrence rate among MIS approaches.
- Disease severity factors beyond patch repair may influence center-specific outcome variations.
Purpose:
Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry.
Methods:
Prospectively collected data from infants with CDH were analyzed from the Congenital Diaphragmatic Hernia Registry from January 1995 to January 2010. Recurrent hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques.
Results:
Five thousand four hundred eighty infants with CDH were identified, of which 4516 (82.4%) were repaired. Operative data were available in 4390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with 12 reported recurrences (7.9%) compared with 114 for open techniques (2.7%, P < .05). Minimally invasive surgery demonstrated a significant increased odds for recurrence (odds ratio, 3.59; 95% confidence interval, 1.92-6.71) after adjusting for gestational age, birth weight, patch repair, and extracorporeal membrane oxygenation.
Conclusion:
Minimally invasive techniques appear to have a significant higher recurrent hernia rate, with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regard to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization.
