Open versus thoracoscopic repair of congenital diaphragmatic hernia: A 19-year review in a tertiary referral centre in Hong Kong [Oral presentation]

Abstract

<p><strong>Purpose</strong></p><p>Congenital diaphragmatic hernia (CDH) is a developmental defect that causes herniation of abdominal organs into the thoracic cavity with significant morbidity and is potentially incompatible with life in severe cases. Thoracoscopic repair of CDH is an increasingly prevalent yet controversial surgical technique, with limited long term outcome data in the Asian region. The aim of this study was to compare open laparotomy versus thoracoscopic repair of CDH in paediatric patients in a major tertiary referral centre in Asia.</p><p><strong>Method</strong></p><p>We performed a retrospective analysis of neonatal patients who had open laparotomy or thoracoscopic repair for CDH in our institution between July 2002 and November 2021. Demographic data, perioperative parameters, recurrence rates and surgical complications were analysed.</p><p><strong>Results</strong></p><p>A total of 64 patients were identified, with 54 left sided CDH cases. 33 patients had a prenatal diagnosis and 35 patients received minimally invasive surgical repair. There was no significant difference between open repair and minimally invasive repair in recurrence rate (13% vs 17%, P=0.713), time to recurrence (184 ± 449 days vs 81 ± 383 days, P=0.502), or median length of ICU stay (11 ± 14 days vs 13 ± 15 days, P=0.343), respectively. Gastrointestinal complications occurred in 7% of neonates in the open group and none in the thoracoscopic group. However, median operation time was significantly longer in the thoracoscopic group (103 ± 46 minutes vs 140 ± 68 minutes, P=0.004). The median follow-up time across all patients was 9.5 years.</p><p><strong>Conclusion</strong></p><p>This study is a large congenital diaphragmatic hernia series in Asia, with long term follow-up demonstrating that there was no significant difference in recurrence rate, time to recurrence or median length of ICU stay between open and minimally invasive repair, suggesting that thoracoscopic approach is a non-inferior surgical option with excellent wound cosmesis and avoidance of gastrointestinal complications compared to open repair.</p>