Abstract
Abstract
Purpose:
To report our technique and experiences in the laparoscopic diaphragmatic hemiplication (LDHP) in children with acquired diaphragmatic eventration after congenital heart surgery.
Subjects and Methods:
Between October 2007 to December 2013, 3498 children with congenital heart disease underwent cardiac surgery in our hospital, and 40 (1.14%) of them had unilateral diaphragmatic elevation on postoperative chest X-ray (mean elevation, 2.5 ± 0.26 intercostal spaces [ICS]) and were diagnosed as having diaphragmatic eventration due to diaphragmatic hemiparesis as a result of phrenic nerve injury. These 40 patients were followed up, and 22 of them recovered after conservative treatment; the other 18 needed surgical intervention. We conducted a retrospective study relating to surgical indications, surgical technique, complications, and outcomes.
Results:
There were 24 boys and 16 girls with a mean age of 10.0 ± 4.5 months old (range, 2 months–4 years). Twenty-two patients did not require surgical intervention. Eighteen patients underwent LDHP (12 cases left-sided and 6 cases right-sided); 2 of them had emergency LDHP with a history of ventilator dependency after cardiac surgery, and 16 of them had planned LDHP with a history of recurrent pneumonia and dyspnea. The operative time was 60 ± 7.9 minutes (range, 45–105 minutes), with minimal blood loss (3 ± 1.5 mL [range, 1–9 mL]), no intra- or postoperative complications, and postoperative hospital stay of 7 ± 1.3 days (range, 5–10 days). The diaphragmatic drop was 2.4 ± 0.2 (range, 2–4 ICS) without recurrence, and the follow-up time for all 40 patients was 14.8 ± 1.6 months (range, 11–36 months).
Conclusions:
Our study further shows that LDHP is feasible and effective in selected patients after congenital heart surgery. Our technique is convenient and provides excellent clinical and radiological results.
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