title: Thoracoscopic repair for congenital diaphragmatic hernia: experience with 139 cases.
abstract: OBJECTIVE
  To analyze indications and to present details of surgical technique and outcomes of thoracoscopic repair for congenital diaphragmatic hernia (CDH) in 139 patients.
  
  
  METHODS
  We reviewed medical records of all patients with CDH who underwent thoracoscopic repair by the same surgical team from June 2001 to October 2009. Patients were placed in the lateral decubitus position. The operations were performed using three trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 2-6 mm Hg. The hernia defect was repaired using nonabsorbable interrupted sutures with extracorporeal knots. A prosthetic patch was used when direct closure of the hernia defect was not feasible.
  
  
  RESULTS
  There were 139 patients, including 91 boys and 48 girls. Seventy-five patients were newborns, and 64 were infants or children. The hernia was located on the left side in 113 patients (81.3%) and on the right side in 26 patients (18.7%). The mean operative time for thoracoscopic approach was 66 ± 27 minutes. Conversion was required in 11 patients (7.9%) from 2001 to 2007. There were no conversions in 2008 or 2009. A prosthetic patch was used in 7 patients. There were 14 postoperative deaths (10%). Follow-up was obtained in 114 patients, ranging from 1 to 84 months (mean 26.3 ± 24.7 months). Five patients had recurrence (3.6%).
  
  
  CONCLUSIONS
  Thoracoscopic repair is feasible and safe for children with CDH, including newborns. The conversion rate decreased, and indications increased with surgical team experience.
authors.affiliation: Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam. liemnhp@hotmail.com
authors.forename: Nguyen Thanh
authors.initials: NT
authors.lastname: Liem
authors.forename: Lo Quang
authors.initials: LQ
authors.lastname: Nhat
authors.forename: To Manh
authors.initials: TM
authors.lastname: Tuan
authors.forename: Le Anh
authors.initials: le A
authors.lastname: Dung
authors.forename: Nguyen Quang
authors.initials: NQ
authors.lastname: Ung
authors.forename: Tran Minh
authors.initials: TM
authors.lastname: Dien
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods