title: Thoracoscopic repair of congenital diaphragmatic hernia by inflation-assisted bowel reduction, in a resuscitated neonate: a better access?
abstract: Elective endoscopic diaphragmatic hernia repairs have been reported. But endoscopic surgery was regarded unsuitable for emergency repair of diaphragmatic hernia in ventilated newborn children in bad general condition. We report a new method for inflation-assisted reduction and thoracoscopic repair of congenital diaphragmatic hernia diaphragmatic in a vitally endangered neonate. From three 2.7 mm to 5 mm accesses warmed low-pressure, low-volume CO2 was inflated into the thorax at 100 ml/min and 2 mm mercury. This allowed spontaneous reduction of the thoracic viscera into the abdomen and diaphragmatic suture with minimal handling. The 65-min procedure was tolerated well without perioperative deterioration. The baby was weaned off the respirator and breast-fed within 2 days, mediastinal shift normalized in 6 days. In suitable infants thoracoscopic repair and inflation-assisted reduction of thoracic contents is a more physiological access to congenital diaphragmatic hernia than laparoscopy or laparotomy.
authors.affiliation: Helios-Centre of Pediatric Surgery, Klinikum Buch, Hobrechtsfelder Chaussee 100, 13125 Berlin, Germany. kschaarschmidt@berlin.helios-kliniken.de
authors.forename: K
authors.initials: K
authors.lastname: Schaarschmidt
authors.forename: J
authors.initials: J
authors.lastname: Strauss
authors.forename: A
authors.initials: A
authors.lastname: Kolberg-Schwerdt
authors.forename: M
authors.initials: M
authors.lastname: Lempe
authors.forename: F
authors.initials: F
authors.lastname: Schlesinger
authors.forename: U
authors.initials: U
authors.lastname: Jaeschke
mesh_terms: D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D011031:Pneumothorax, Artificial; D012121:Respiration, Artificial; D012151:Resuscitation; D013906:Thoracoscopy