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Surgical treatment of congenital diaphragmatic hernia in a single institution
Hua Li1,2,3, Shengliang Zhao1,2,3, Chun Wu2,3
1Children's Hospital of Chongqing Medical University; Department of Cardio-Thoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders;Chongqing Key laboratory of Pediatrics, Chongqing, 400037, People's Republic of China.
Insights
Video-assisted thoracic surgery offers a less invasive approach for congenital diaphragmatic hernia (CDH) treatment, showing reduced complications and faster recovery compared to open surgery. However, recurrence rates may be higher with thoracoscopy.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring surgical intervention.
- Conventional open surgery has been the standard treatment for CDH.
- Minimally invasive techniques are being explored to improve patient outcomes.
Purpose of the Study:
- To compare the effectiveness of video-assisted thoracic surgery (VATS) with conventional open surgery for CDH treatment in infants.
- To evaluate surgical outcomes including operation time, blood loss, recovery period, and complication rates.
- To assess the recurrence and mortality rates associated with both surgical approaches.
Main Methods:
- Retrospective analysis of 109 pediatric CDH cases from 2011-2021.
- Comparison between a thoracoscopy group (47 cases) and an open surgery group (62 cases).
- Assessment of diaphragmatic defect size, operative parameters, and postoperative outcomes.
Main Results:
- Thoracoscopy group demonstrated significantly shorter operation times, less blood loss, and reduced postoperative recovery periods (ventilation, hospital stay, CCU admission).
- Lower incidence of postoperative complications, including infections and pleural effusions, was observed in the thoracoscopy group.
- The thoracoscopy group had a higher recurrence rate (8.51%) compared to the open group (3.23%), but zero mortality versus 7 deaths in the open group.
Conclusions:
- Both thoracoscopic surgery and open surgery are effective for CDH treatment.
- Thoracoscopy offers advantages in reduced trauma, shorter operation time, and fewer complications.
- While thoracoscopy shows promise for specific defect types (A/B), vigilance for recurrence is necessary.
Background:
This study aimed to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of congenital diaphragmatic hernia (CDH) in a larger series compared with conventional open surgery. Additionally, we summarized the experience of thoracoscopic surgery in the treatment of CDH in infants.
Methods:
We retrospectively analysed the clinical data of 109 children with CDH who underwent surgical treatment at the Department of Cardiothoracic Surgery of Children's Hospital of Chongqing Medical University from January 2011 to January 2021. According to the surgical method, the children were divided into an open group (62 cases) and a thoracoscopy group (47 cases).Patients who underwent surgical correction had the diaphragmatic defect size graded (A-D) using a standardized system. We compared the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay, postoperative CCU admission time and other surgical indicators as well as the recurrence rate, mortality rate and complication rate of the two groups of children.
Results:
The index data on the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). We compared the number of incision infections, lung infections, atelectasis, pleural effusion, and chylothorax between the two groups. There were more children in the open group than in the thoracoscopy group. The overall incidence of postoperative complications in the open group (51.61%) was higher than that in the thoracoscopy group (44.68%).The recurrence rate of the thoracoscopy group (8.51%) was higher than that of the open group (3.23%). In the open group, 7 patients died of respiratory distress after surgery, and no patients died in the thoracoscopy group.
Conclusions:
Thoracoscopic surgery and open surgery can effectively treat CDH. Compared with conventional open surgery, thoracoscopy has the advantages of shorter operation time, less trauma, faster recovery and fewer complications. We believe that thoracoscopic surgery for type A/B diaphragmatic defect has certain advantages, but there is a risk of recurrence.
