Multimedia article. Thoracoscopic patch repair of a right-sided congenital diaphragmatic hernia in a neonate.
OBJECTIVE
Minimally invasive techniques continue to expand in pediatric surgery; however, there has been some debate over the appropriate operative technique for the management of congenital diaphragmatic hernias in neonates. We present a video of a thoracoscopic patch repair of a right-sided Bochdalek congenital diaphragmatic hernia (CDH) in a 3-day-old male.


METHODS
Our patient was noted to have a right-sided CDH on chest X-ray following respiratory distress at the time of birth. The patient's remaining neonatal workup also confirmed hypoplastic transverse aortic arch with coarctation, ventricular septal defect (VSD), and patent ductus arteriosus, which were initially diagnosed by prenatal ultrasound. After monitoring the patient for hemodynamic stability and discussion with the family and involved pediatric cardiothoracic surgeons, the decision was made to proceed with a thoracoscopic repair of the CDH.


RESULTS
The large right-sided CDH was noted to involve herniated small bowel, colon, and liver. The diaphragmatic defect was successfully repaired thoracoscopically using a 5 x 5 cm polytetrafluoroethylene (PTFE) patch. The patient was extubated on the second postoperative day and ultimately underwent aortic arch augmentation, VSD closure, and patent ductus arteriosus ligation and division at 1 month of age. There has been no evidence of CDH recurrence in follow-up.


CONCLUSIONS
As demonstrated by our video, large right-sided congenital diaphragmatic hernias requiring patch repair can be successfully repaired thoracoscopically with appropriate surgeon comfort and experience. This minimally invasive approach may also be used in neonates with associated cardiac defects with appropriate cardiothoracic surgical consultation and support. To our knowledge this is the first reported case of a thoracoscopic repair of a Bochdalek (posterolateral) hernia with a prosthetic patch in a neonate with significant congenital cardiac anomalies.
Shah
Sohail R
SR
Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, 3705 Fifth Ave., 4A-485, Pittsburgh, PA 15213, USA, sohail.shah@chp.edu
Gittes
George K
GK
Barsness
Katherine A
KA
Kane
Timothy D
TD
D006548:Hernia, Diaphragmatic / Q000473:pathology / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011138:Polytetrafluoroethylene; D013526:Surgical Mesh; D013906:Thoracoscopy / Q000379:methods*
D011138:Polytetrafluoroethylene