Thoracoscopic repair for congenital diaphragmatic hernia: lessons from 45 cases.
OBJECTIVE
To describe the surgical technique, initial results, and overview indications of thoracoscopic repair of congenital diaphragmatic hernia (CDH).


METHODS
A retrospective review was undertaken of patients with CDH who underwent thoracoscopic repair by the same surgeon from January 2001 to January 2005. Patients underwent surgery under general anesthesia. Reduction of the hernia contents was carried out using 1 optical trocar and 2 operating trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 2 to 4 mm Hg. The hernia defect was repaired using nonabsorbable interrupted sutures with extracorporeal knots.


RESULTS
There were 45 patients, including 29 boys and 16 girls. Among 19 newborn patients, there were 13 patients younger than 7 days. The other 26 patients were infants and elders. The hernia was located in the left side in 37 patients and in the right side in 8 patients. The mean operative time was 54 minutes. Conversion was required in 4 patients. There were no complications. However, there were 2 postoperative deaths.


CONCLUSIONS
Thoracoscopic repair is feasible and safe for children with CDH, including selective newborn. The technique causes minimal trauma, results in good respiratory function, and promotes early recovery.
Nguyen
Thanh Liem
TL
Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam. nipliem@hotmail.com
Le
Anh Dung
AD
D000368:Aged; D004322:Drainage; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010996:Pleural Effusion / Q000453:epidemiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D013906:Thoracoscopy