Thoracoscopic repair of neonatal diaphragmatic hernia

Yigit S. Guner, Nikunj Chokshi, Arturo Aranda, Christian Ochoa, Faisal G. Qureshi, Nam X. Nguyen, Tracy Grikscheit, Henri R. Ford, James E. Stein, Cathy E. Shin

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Introduction: The use of minimally invasive surgery (MIS) in the neonatal population is increasing. Thoracoscopic intervention for congenital diaphragmatic hernia (CDH) is no exception. In this report, we describe our initial experience with thoracoscopic repair of left-sided diaphragmatic defects in neonates. Materials and Methods: We performed retrospective chart reviews on all neonates who underwent thoracoscopic repair of CDH between November 2004 and January 2008. Neonates that underwent thoracoscopic repair were physiologically stable with resolved pulmonary hypertension and minimal to moderate ventilatory support. They had no associated cardiac anomalies. Results: We identified 15 neonates with CDH who underwent thoracoscopic repair during the study period. Ten neonates underwent primary repair of the diaphragmatic defect. Five neonates with large defects required closure with a synthetic patch, which was placed thoracoscopically. The average operating room time was 134 minutes. There were no instances of intraoperative respiratory or cardiac instability. Three patients had a recurrence. One recurrence was seen after thoracoscopic patch repair. Two recurrences occurred following primary repair of left diaphragmatic hernias. There were no deaths. Follow-up has been 4-40 months. Conclusions: Neonatal MIS for CDH should be limited to stable patients. The ideal candidate is the newborn without associated anomalies, not requiring extracorporeal membrane oxygenation, on minimal ventilatory support, and without evidence of pulmonary hypertension. It is technically possible to perform thoracoscopic repair with a patch.

Original languageEnglish (US)
Pages (from-to)875-880
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume18
Issue number6
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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