Abstract
Purpose
: To present our experience with minimally invasive surgery for central and left-sided diaphragmatic defects in the neonate and infants.
Methods
: For congenital diaphragmatic hernia (CDH), the laparoscopic technique is helped by a port position well out in the left flank, a hitch stitch to hold the posterior muscle shelf forward during the repair, and the patient positioned with the head up and the left side rotated well forwards. For hemi-diaphragmatic palsy, in addition, two rows of plication could be achieved only after the left lobe of the liver had been detached from the diaphragm. For Morgagni hernia, the defect was closed with muscle-to-muscle sutures, with the patient supine.
Results
: Four patients, ranging in age from a neonate to 18 months, underwent successful primary laparoscopic repair of one Morgagni hernia, one hemi-diaphragmatic palsy, and two diaphragmatic hernias. Presenting symptoms ranged from minor, to one neonate requiring ventilatory support. The maximum length of stay after surgery was 6 days. There were no complications.
Conclusion
: This series demonstrated the feasibility of laparoscopic repair of central and left-sided diaphragmatic defects in children. The laparoscopic techniques are discussed, as are the steps which improved access and made the procedure easier.
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