Laparoscopic Resection of Pulmonary Sequestration in an Infant with Congenital Diaphragmatic Hernia

Abstract

Laparoscopic repair (LR) of late-onset congenital diaphragmatic hernia (CDH) is not a common procedure in infants. We report a successful LR of a left CDH combined with laparoscopic resection of an extralobar pulmonary sequestration. A 4-month-old infant was incidentally diagnosed with left CDH from a chest x-ray. After detailed imaging studies, LR was performed with one optical trocar and three working trocars. Laparoscopy revealed a left CDH with a sac and intestinal herniation. Subsequently, the hernia contents were reduced and the hernia sac was excised by laparoscopic coagulation shears. Laparoscopy also revealed an extralobar pulmonary sequestration and a small lung in the left thoracic cavity. The sequestration was resected using a GIA stapler, and the defects of the diaphragm were directly sutured using nonabsorbable sutures. The patient had an uneventful recovery following a short hospital stay.

Conclusion:

The laparoscopic approach can be an effective and more advantageous alternative to laparotomy for CDH in the pediatric population. A laparoscopic approach for late-onset CDH is extremely useful, not only as a minimally invasive procedure, but also for precise evaluation of associated intrathoracic complications.