Early Outcomes of Thoracoscopic Repair of Congenital Diaphragmatic Hernia (Cdh): Two entres’ Experience

Abstract

Introduction: With the successful development of minimal invasive surgery in neonates and early infants, thoracoscopic repair of congenital diaphragmatic hernia (CDH) is gaining popularity. We report our experience in performing this operation and compared this to the traditional open approach. Material & method: The medical records of all neonates and infants with CDH operated in the past ten years (2001-2011) were reviewed. They were divided into two groups according to laparotomy or thoracoscopic approaches. The open approach was used up to 2009 when we changed our practice to thoracoscopic repair. Demographic data and clinical outcomes of both groups were analyzed separately. Statistical analysis was performed by SPSS v15.0. Results: A total of 40 patients (male:female = 27: 13) were identified (23 in open and 17 in thoracoscopic group). Nearly all patients had the defect located on left side. One patients in the thoracoscopic group needed conversion to laparotomy due to intra-operative instability. While there was no statistical difference in terms of age at operation, sex, body weight and the location of defect, the mean operative duration was slightly longer in patients operated thoracoscopically (123.23+/-36.03mins vs. 109.8+/-32.6mins, p=0.8). Repair with prosthetic patch was needed in 7 patients in the open group and 1 patient in the thoracoscopy group. Early post-operative complications (wound infection, hematoma) were more frequently encountered in the open group, although this was not statistically significant (8:3, p=0.6). There was one recurrence in each group. Conclusion: Thoracoscopic repair of CDH in neonates and young infants seems to be feasible and safe, with comparable early clinical outcomes to traditional open surgery. The slightly longer operating times may be off set by less trauma to the patients and earlier discharge.