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Thoracoscopic repair of recurrent bochdalek diaphragmatic hernias in children
Shaun M Kunisaki1, Ian A Powelson, Steven W Bruch
1Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System , C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA. shaunkun@umich.edu
Insights
Minimally invasive thoracoscopic repair is a viable option for recurrent congenital diaphragmatic hernias (CDH) in children. This technique showed comparable outcomes to open repair, offering a safe alternative for selected cases.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Recurrent herniation is a common complication after initial congenital diaphragmatic hernia (CDH) repair.
- The efficacy of minimally invasive techniques for recurrent CDH is not well-established.
Purpose of the Study:
- To evaluate the early experience of thoracoscopic repair versus traditional open repair for recurrent CDH in children.
Main Methods:
- Retrospective review of 24 recurrent Bochdalek CDH cases (1990-2011).
- Comparison of thoracoscopic repair outcomes with open repair using statistical tests (unpaired t test, Fisher's exact test).
Main Results:
- Thoracoscopic repair was attempted in 6 children (25%), with 4 successful conversions.
- Mean age at repair: 11.5 months; mean operative time: 191 minutes.
- No deaths or recurrences observed; no significant differences compared to open repair.
Conclusions:
- Thoracoscopic repair is a feasible alternative for selected pediatric patients with recurrent Bochdalek diaphragmatic hernias.
Background:
Recurrent herniation is a well-known complication following the initial repair of congenital diaphragmatic hernias (CDHs). The role of minimally invasive surgical techniques in recurrent CDH remains undefined. The purpose of this study was to evaluate our early experience with thoracoscopic repair compared with traditional open repair in children with recurrent CDH.
Subjects And Methods:
We retrospectively reviewed all recurrent Bochdalek CDH cases (n=24) managed at a single tertiary-care referral center between January 1990 and March 2011. Children who underwent thoracoscopic repair for recurrent CDH were identified, and their data were compared by the unpaired t test and the two-sided Fisher's exact test, as appropriate, with those of children who underwent open repair. Significance was defined as P<.05.
Results:
Thoracoscopic repair was attempted in 6 (25%) children with recurrent CDH. Four (67%) repairs were successfully completed without conversion to an open procedure. The mean age at thoracoscopic repair was 11.5 months (range, 8.1-16.1 months). The mean operative time was 191 minutes (range, 94-296 minutes), and all children were extubated within 24 hours. The mean hospital length of stay was 3.75 days (range, 1-6 days). There were no deaths or subsequent recurrences after a mean follow-up of 26.5 months (range, 14.3-41.3 months). There were no statistical differences in any of the measured outcome variables when compared with the open repair group.
Conclusions:
Our initial experience suggests that thoracoscopic repair is a feasible alternative to open repair in selected children with recurrent Bochdalek diaphragmatic hernias.
