Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg 2003 Nov;38(11):1563-8
Date
11/14/2003Pubmed ID
14614701DOI
10.1016/s0022-3468(03)00564-5Scopus ID
2-s2.0-0242693217 (requires institutional sign-in at Scopus site) 167 CitationsAbstract
BACKGROUND: Minimally invasive surgery (MIS) for the repair of congenital diaphragmatic hernias (CDH) had been described. This report reviews the authors' experience with MIS repairs of CDH and discusses the technical development of this approach.
METHODS: From 1999 until now, the authors collected data on children who underwent an MIS approach for CDH repair.
RESULTS: Seventeen children (11 Morgagni and 7 Bochdalek) had undergone an attempt at MIS repair. All Morgagni defects were treated successfully using laparoscopy (mean age, 28 +/- 31 months). Mean follow-up was 22 +/- 9 months. There was 1 recurrence. Four children with Bochdalek CDH were treated as newborns (range, 3 to 21 days), and 3 had operations later (4, 11, and 32 months). The first repair was attempted initially transabdominally and was converted to a thoracoscopic approach. The rest of the Bochdalek repairs were performed thoracoscopically. Bochdalek repairs via MIS were successful in 3 children (2 older children and 1 neonate). No child had pulmonary hypertension. Two of the 3 Bochdalek patients did well postoperatively (follow-up, 18 +/- 7 months); the last patient experienced recurrence 11 months after repair.
CONCLUSIONS: MIS for CDH is ideal for Morgagni defects. It should be considered for nonnewborns with a Bochdalek CDH. The MIS approach for a newborn with a CDH cannot be recommended because of the high failure rate and frequent rise in PCO2 levels.
Author List
Arca MJ, Barnhart DC, Lelli JL Jr, Greenfeld J, Harmon CM, Hirschl RB, Teitelbaum DHMESH terms used to index this publication - Major topics in bold
Child, PreschoolColon
Hernia, Diaphragmatic
Hernias, Diaphragmatic, Congenital
Humans
Hypercapnia
Infant
Infant, Newborn
Intraoperative Complications
Laparoscopy
Minimally Invasive Surgical Procedures
Monitoring, Intraoperative
Pneumoperitoneum, Artificial
Recurrence
Retrospective Studies
Surgical Mesh
Treatment Outcome
