A Simplified Surgical Technique for Thoracoscopic Repair of Congenital Diaphragmatic Hernia

Abstract

Introduction:

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.

Materials and Methods:

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.

Results:

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.

Conclusion:

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.