Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence.
BACKGROUND
Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has been described, but its efficacy and safety have not been validated. The aim was to compare our experience of thoracoscopy with laparotomy repair.


METHODS
After ethics approval, we reviewed the notes of neonates with CDH operated in our institution between 2003 and 2008. Two historical groups were compared: infants who underwent laparotomy (2003-2008) or thoracoscopy (2007-2008). Data were compared by t test or Mann-Whitney tests.


RESULTS
Thirty-five children had open repair of CDH, and 13 had thoracoscopic repair. Groups were homogeneous for age and weight. Five (38%) neonates who had thoracoscopy were converted to open for surgical difficulties (n = 4) and O(2) desaturation (n = 1). Patch repair was used in 12 (34%) open and 6 (46%) thoracoscopic repairs. End-tidal CO(2) was significantly elevated during thoracoscopy, but this was not reflected in arterial CO(2) or pH. There were 3 (8%) recurrences after open repair and 2 (25%) after thoracoscopy (P = .19).


CONCLUSIONS
Thoracoscopic repair of CDH is feasible. Arterial blood gases should be closely monitored. Despite higher EtCO(2), conversion to open was mainly because of difficult repair. A randomized trial is necessary to assess the effect of thoracoscopy on ventilation and recurrences.
McHoney
Merrill
M
Department of Paediatric Surgery, Great Ormond Street Hospital and the UCL Institute of Child Health, London WC1N 1EH, UK.
Giacomello
Luca
L
Nah
Shireen A
SA
De Coppi
Paolo
P
Kiely
Edward M
EM
Curry
Joe I
JI
Drake
David P
DP
Eaton
Simon
S
Pierro
Agostino
A
D000137:Acid-Base Imbalance / Q000517:prevention & control; D001774:Blood Chemical Analysis; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006548:Hernia, Diaphragmatic / Q000097:blood / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006935:Hypercapnia / Q000517:prevention & control; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D007327:Insufflation; D007430:Intraoperative Care; D007813:Laparotomy / Q000379:methods; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D012121:Respiration, Artificial / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
D002245:Carbon Dioxide