title: Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned.
abstract: 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.
authors: Department of Surgery, University of Michigan Medical School and the C.S. Mott Children's Hospital, Ann Arbor, MI 53226, USA.
authors: Marjorie J
authors: MJ
authors: Arca
authors: Douglas C
authors: DC
authors: Barnhart
authors: Joseph L
authors: JL
authors: Lelli
authors: Jonathon
authors: J
authors: Greenfeld
authors: Carroll M
authors: CM
authors: Harmon
authors: Ronald B
authors: RB
authors: Hirschl
authors: Daniel H
authors: DH
authors: Teitelbaum
mesh_terms: D002675:Child, Preschool; D003106:Colon / Q000293:injuries; D006548:Hernia, Diaphragmatic / Q000145:classification / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000517:prevention & control; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000639:trends; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome