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Comparative Study of Thoracoscopic and Modified Small Incision Repair for Congenital Diaphragmatic Eventration in
Yuanxia Cai1, Yeming Wu1, Zhixiang Wu1
1Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Insights
Thoracoscopic diaphragmatic plication for congenital diaphragmatic eventration (CDE) shows better outcomes than small incision surgery. This minimally invasive approach reduces blood loss and thoracic deformities, offering a safer treatment for CDE patients.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Congenital diaphragmatic eventration (CDE) treatment often involves diaphragmatic plication.
- Thoracoscopic surgery is increasingly used, but comparisons with open approaches are limited.
Purpose of the Study:
- To compare the therapeutic effects and prognosis of thoracoscopic diaphragmatic plication versus modified small incision plication for CDE in children.
Main Methods:
- Retrospective analysis of 77 children with CDE treated between 2006 and 2019.
- Patients were divided into thoracoscopic plication and modified small incision plication groups.
- Comparison of perioperative characteristics and follow-up data.
Main Results:
- No significant differences in preoperative characteristics or postoperative hospital stays.
- Thoracoscopic group had significantly less blood loss and lower need for chest drainage.
- No recurrence in either group, but fewer thoracic deformities post-thoracoscopic plication.
Conclusions:
- Thoracoscopic diaphragmatic plication is advantageous over modified small incision plication for CDE.
- Benefits include reduced blood loss, less need for drainage, and prevention of thoracic deformities.
Abstract:
Thoracoscopic diaphragmatic plication has gained popularity in the treatment of congenital diaphragmatic eventration (CDE), but the therapeutic effect and prognosis have rarely been compared with nonendoscopic surgery. The medical records of 77 children who had received treatment for CDE in our institution from September 2006 to January 2019 were retrospectively analyzed. According to the repair approach, the children were divided into a thoracoscopic plication group and a modified small incision plication group. The perioperative characteristics and follow-up details after diaphragm plication were compared between the two groups. Among 77 children with CDE, 44 cases were in the thoracoscopic plication group and 33 cases were in the modified small incision plication group. All the cases of CDE were unilateral, with 13 cases on the left side and 64 cases on the right side. There were no differences in the preoperative characteristics between the two groups. The modified small incision plication group had a higher bleeding volume (P = .000) and a greater proportion of patients needing chest drainage (P = .000), whereas the differences in the total and postoperative hospital stays (P = .088, P = .247, respectively) did not significantly differ between the two groups. There were no differences in postoperative improvement in the location of the diaphragm between the two groups or between the right and left lesions (P = .438, P = .677, respectively). The total follow-up time was 2-11 years. No recurrence was reported during this period in either of the groups, but the incidence of postoperative thoracic deformities was higher in the modified small incision plication group (P = .013). Compared with the modified small incision plication, thoracoscopic plication has the advantages of smaller blood loss, a low percentage of intrathoracic drainage tube usage, and no occurrence of thoracic deformities.
