A Simplified Surgical Technique for Thoracoscopic Repair of Congenital Diaphragmatic Hernia

The current surgical approaches for treating congenital diaphragmatic hernia (CDH) are challenging. Thoracoscopic transcutaneous closure of CDH is described, of which a retrospective study was conducted to investigate the safety and effectiveness.

In thoracoscopic transcutaneous closure, a thoracoscope and operating forceps are placed through two intercostal ports to expose the defect, followed by stepwise thoracic pressure elevation to facilitate herniated organ reduction. A fascial closure device is introduced through a small skin incision to encircle the diaphragmatic rim in two semicircular passes, and the suture is then tightened extracorporeally to close the defect.

Over a 8-year period, 33 TTC repairs were performed for CDH, including 31 Bochdalek and 2 Morgagni cases. Bochdalek repairs were completed in a mean operative time of 53.68 ± 45.81 minutes (range, 10-200 minutes), with a median age of 1 day and median weight of 3.25 kg. Among them, two patients experienced recurrence at 3 months and 7 months postoperatively. During hospitalization, four patients developed pneumothorax, and one patient developed chylothorax. The two Morgagni cases were repaired in 35 and 30 minutes at 5 and 6 months of age. Respiratory support was a median of 59 hours (range, 0-352 hours) in patients who required respiratory assistance, intensive care unit stay was a median of 15 days (range, 1-91 days) in patients admitted to the intensive care unit, and hospital stay was a median of 15 days (range, 2-91 days). All patients had uneventful wound healing without rib-development complications during follow-up.

Thoracoscopic transcutaneous closure is a feasible and effective technique to treat CDH. While possessing the advantages of minimally invasive surgery, it shortens the operative time and learning curve.