Thoracoscopic repair in congenital diaphragmatic hernia: patching is safe and reduces the recurrence rate.
OBJECTIVE
Congenital diaphragmatic hernia (CDH) has traditionally been repaired via a laparotomy. More and more reports on thoracoscopic repair are being published. The aim of this study was to evaluate our series of thoracoscopic CDH repair and compare this group to an open repair group treated during the same period in the same institute.


METHODS
Between June 2006 and December 2008, 49 children with posterolateral CDH were admitted, of whom 23 (47%) were operated thoracoscopically and 23 (47%) using an open repair, depending on the discretion of the attending surgeon and the clinical condition of the patient. Three patients (6%) with CDH were not treated because of associated anomalies (twice Cornelia de Lange syndrome and once hypoplastic left heart syndrome). Six thoracoscopic operations (26%) were converted to open surgery. Nine defects (39%) were closed thoracoscopically without a patch. In 8 (35%) patients, a patch was used. We used a patch in 20 open procedures (87%).


RESULTS
Three (33%) of the 9 thoracoscopic repairs without patch and 1 (12%) of the 8 with a patch developed a recurrence. All these recurrences were repaired thoracoscopically. The 3 recurrences from the thoracoscopic primary repair were repaired using a patch. In the open group, 3 patients (13%) developed a recurrence, of whom 2 were repaired thoracoscopically. Mean operative time was significantly longer in the thoracoscopic patch repair group (158 minutes), when compared to the open repair group (125 minutes).


CONCLUSIONS
As in open repair, it seems wise to use large patches liberally, not only to reconstruct the dome of the diaphragm but also to avoid undue tension on the repair and prevent recurrences. The thoracoscopic approach is also considered feasible in case of a recurrence from either a thoracoscopic or open repair.
Keijzer
Richard
R
Department of Pediatric Surgery, ErasmusMC-Sophia, PO Box 2060, 3000 CB, Rotterdam, The Netherlands. richardkeijzer@gmail.com
van de Ven
Cees
C
Vlot
John
J
Sloots
Cornelius
C
Madern
Gerard
G
Tibboel
Dick
D
Bax
Klaas
K
D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009426:Netherlands; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D012189:Retrospective Studies; D013526:Surgical Mesh; D013906:Thoracoscopy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene