title: Thoracoscopic repair of neonatal diaphragmatic hernia.
abstract: BACKGROUND
  The use of minimally invasive surgery (MIS) in the neonatal population is increasing. Thoracoscopic intervention for congenital diaphragmatic hernia (CDH) is no exception. In this report, we describe our initial experience with thoracoscopic repair of left-sided diaphragmatic defects in neonates.
  
  
  METHODS
  We performed retrospective chart reviews on all neonates who underwent thoracoscopic repair of CDH between November 2004 and January 2008. Neonates that underwent thoracoscopic repair were physiologically stable with resolved pulmonary hypertension and minimal to moderate ventilatory support. They had no associated cardiac anomalies.
  
  
  RESULTS
  We identified 15 neonates with CDH who underwent thoracoscopic repair during the study period. Ten neonates underwent primary repair of the diaphragmatic defect. Five neonates with large defects required closure with a synthetic patch, which was placed thoracoscopically. The average operating room time was 134 minutes. There were no instances of intraoperative respiratory or cardiac instability. Three patients had a recurrence. One recurrence was seen after thoracoscopic patch repair. Two recurrences occurred following primary repair of left diaphragmatic hernias. There were no deaths. Follow-up has been 4-40 months.
  
  
  CONCLUSIONS
  Neonatal MIS for CDH should be limited to stable patients. The ideal candidate is the newborn without associated anomalies, not requiring extracorporeal membrane oxygenation, on minimal ventilatory support, and without evidence of pulmonary hypertension. It is technically possible to perform thoracoscopic repair with a patch.
authors.affiliation: Department of Pediatric Surgery, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027, USA.
authors.forename: Yigit S
authors.initials: YS
authors.lastname: Guner
authors.forename: Nikunj
authors.initials: N
authors.lastname: Chokshi
authors.forename: Arturo
authors.initials: A
authors.lastname: Aranda
authors.forename: Christian
authors.initials: C
authors.lastname: Ochoa
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Qureshi
authors.forename: Nam X
authors.initials: NX
authors.lastname: Nguyen
authors.forename: Tracy
authors.initials: T
authors.lastname: Grikscheit
authors.forename: Henri R
authors.initials: HR
authors.lastname: Ford
authors.forename: James E
authors.initials: JE
authors.lastname: Stein
authors.forename: Cathy E
authors.initials: CE
authors.lastname: Shin
mesh_terms: D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D012189:Retrospective Studies; D013526:Surgical Mesh; D013906:Thoracoscopy; D016896:Treatment Outcome