Back to Search Start Over

A Multi-Institutional Review of Thoracoscopic Congenital Diaphragmatic Hernia Repair

Authors :
Shawn D. St. Peter
Lena Perger
Manabu Okawada
Peter C. Minneci
Katrina L. Weaver
Joanne Baerg
Go Miyano
Martin Lacher
Katherine A. Barsness
Dani O. Gonzalez
Source :
Journal of Laparoendoscopic & Advanced Surgical Techniques. 26:825-830
Publication Year :
2016
Publisher :
Mary Ann Liebert Inc, 2016.

Abstract

Thoracoscopic repair of a congenital diaphragmatic hernia (CDH) in the neonate is controversial due to reports of increased hernia recurrence. A multicenter review on thoracoscopic CDH repair was conducted to evaluate outcomes and to identify factors that are associated with recurrence.A multicenter retrospective review was conducted from 2009 to 2015 in neonates who were treated for CDH with thoracoscopic repair. Demographics, preoperative, intraoperative, including repair techniques, and postoperative variables were analyzed by using descriptive statistics. Comparative analysis was performed between those patients who were repaired entirely thoracoscopically with hernia recurrence and those without.One hundred nine infants, of whom 57% were male with an average gestational age at time of surgery of 39.6 ± 4.6 weeks and a weight of 3.4 ± 1.1 kg, were included. The median age at repair was 5 days (range: 3-9), 61% patients required vasopressor support, and 1.8% patients required extracorporeal membrane oxygenation (ECMO) cannulation before repair. Forty-five percent were repaired on high-frequency oscillatory ventilation (HFOV). Repair was completed thoracoscopically in 83 patients (76%), 68 (82%) were repaired primarily, 15 (18%) were repaired with a patch, and 50 (60%) had extracorporeal/rib fixation sutures. Recurrence occurred in 7 (8.4%) of those completed thoracoscopically. Factors found to be significant for recurrence included: vasopressor therapy (P = .02), repair on HFOV (P = .04), and the presence of the spleen in the chest (P = .04). There was no significant difference identified between technical variations in repair.These data suggest that thoracoscopic repair of CDH is feasible in carefully selected patients. However, there is currently no evidence to support a standardized surgical approach to thoracoscopic repair.

Details

ISSN :
15579034 and 10926429
Volume :
26
Database :
OpenAIRE
Journal :
Journal of Laparoendoscopic & Advanced Surgical Techniques
Accession number :
edsair.doi.dedup.....e5c271682d5428fa31b78c5b85ff5882
Full Text :
https://doi.org/10.1089/lap.2016.0358