Indications for thoracoscopic repair of congenital diaphragmatic hernia in neonates.
OBJECTIVE
We reviewed 26 consecutive cases of congenital diaphragmatic hernia (CDH) prospectively to establish selection criteria for successful thoracoscopic CDH repair (TR).


METHODS
Five preoperative deaths were excluded, leaving 21 subjects. TR was only considered once pulmonary hypertension (PH) improved on echocardiography, and if cardiopulmonary status was stable in the decubitus position in the neonatal intensive care unit (NICU) under conventional mechanical or high-frequency oscillatory ventilation (HFOV) with/without nitric oxide (NO) for at least 10 min as a marker for tolerating surgery and manual ventilation was possible for transfer to the operating room. All other patients had open repair (OR).


RESULTS
8/21 had TR and 13/21 had OR. There were significant differences between TR and OR for prenatal diagnosis (37.5 vs. 84.6%, p < 0.05) and earlier surgery (1.4 ± 0.8 vs. 2.5 ± 1.1 days after birth, p < 0.05), respectively. Intraoperative HFOV was required in all OR and 3 TR (p < 0.01). NO was required in 1 TR and 10 OR (p < 0.01). Organ herniation was significantly less in TR (50 vs. 100%, p < 0.01 for stomach; 0 vs. 54%, p < 0.05 for liver). Three TR required conversion to OR because of technical difficulties. One OR died from deteriorating PH.


CONCLUSIONS
Our selection criteria for TR would appear to be safe and reasonable.
Okazaki
Tadaharu
T
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Bunkyo-Ku, Tokyo, Japan. okazakit@juntendo.ac.jp
Nishimura
Kinya
K
Takahashi
Toshiaki
T
Shoji
Hiromichi
H
Shimizu
Toshiaki
T
Tanaka
Toshitaka
T
Takeda
Satoru
S
Inada
Eiichi
E
Lane
Geoffrey J
GJ
Yamataka
Atsuyuki
A
D001993:Bronchodilator Agents / Q000008:administration & dosage; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage; D011446:Prospective Studies; D012121:Respiration, Artificial; D016019:Survival Analysis; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D009569:Nitric Oxide