Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned.
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.
Arca
Marjorie J
MJ
Department of Surgery, University of Michigan Medical School and the C.S. Mott Children's Hospital, Ann Arbor, MI 53226, USA.
Barnhart
Douglas C
DC
Lelli
Joseph L
JL
Greenfeld
Jonathon
J
Harmon
Carroll M
CM
Hirschl
Ronald B
RB
Teitelbaum
Daniel H
DH
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