Related Experiment Video
Updated: Jul 12, 2025
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Reduced Long-Term Bowel Obstruction Risk With Minimally Invasive Diaphragmatic Hernia Repair
Gerard R Martusciello1, Gwyneth A Sullivan1, Nathaniel Koo1
1Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois.
Introduction:
The introduction of minimally invasive surgery (MIS) for repair of congenital diaphragmatic hernias (CDH) has reduced postoperative length of stay, postoperative opioid consumption, and provided a more esthetic repair. In adult abdominal surgery, minimally invasive techniques have been associated with decreased long-term rates of small bowel obstruction (SBO), although it is unclear if this benefit carries over into the pediatric population. Our objective was to evaluate the rates of SBO following open versus MIS CDH repair.
Material And Methods:
Infants who underwent CDH repair between 2010 and 2021 were identified using the PearlDiver Mariner database. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate time to SBO by surgical approach (MIS versus open) while adjusting for mesh use, patient sex, and length of stay.
Results:
Of 1033 patients that underwent CDH repair, 258 (25.0%) underwent a minimally invasive approach. The overall rate of SBO was 7.5% (n = 77). Rate of SBO following MIS repair was lower than open repair at 1 y (0.8% versus 5.1%), 3 y, (2.3% versus 9.0%), and 5 y (4.4% versus 10.1%, P = 0.004). Following adjustment, the rate of SBO following MIS repair remained significantly lower than open repair (adjusted hazard ratio: 0.37, 95% confidence interval: 0.18, 0.79).
Conclusions:
Following CDH repair, long-term rates of SBO are lower among patients treated with MIS approaches. Long-term risk of SBO should be considered when selecting surgical approach for CDH patients.
Insights
Minimally invasive surgery (MIS) for congenital diaphragmatic hernia (CDH) repair significantly reduces the long-term risk of small bowel obstruction (SBO). MIS approaches offer a safer alternative for pediatric CDH repair compared to open surgery.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Minimally invasive surgery (MIS) for congenital diaphragmatic hernia (CDH) repair offers benefits like shorter hospital stays and improved aesthetics.
- While MIS is linked to reduced long-term small bowel obstruction (SBO) in adults, its impact on pediatric CDH repair outcomes is less clear.
Purpose of the Study:
- To compare the rates of small bowel obstruction (SBO) following open versus minimally invasive surgery (MIS) for congenital diaphragmatic hernia (CDH) repair in pediatric patients.
Main Methods:
- A retrospective analysis of pediatric patients who underwent CDH repair between 2010 and 2021 was conducted using the PearlDiver Mariner database.
- Kaplan-Meier curves and Cox proportional hazards models were employed to assess the time to SBO, adjusting for mesh use, sex, and length of stay.
Main Results:
- The study included 1033 patients, with 25.0% undergoing MIS repair. The overall SBO rate was 7.5%.
- Rates of SBO were consistently lower for MIS compared to open repair at 1, 3, and 5 years post-surgery (P=0.004).
- Adjusted analysis confirmed that MIS repair was associated with a significantly lower rate of SBO (adjusted hazard ratio: 0.37).
Conclusions:
- Minimally invasive surgery (MIS) approaches are associated with reduced long-term rates of small bowel obstruction (SBO) after congenital diaphragmatic hernia (CDH) repair.
- The long-term risk of SBO should be a key consideration when selecting the surgical approach for pediatric CDH patients.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...