title: Minimally invasive repair of congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry.
  
  
  METHODS
  Prospectively collected data from infants with CDH were analyzed from the Congenital Diaphragmatic Hernia Registry from January 1995 to January 2010. Recurrent hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques.
  
  
  RESULTS
  Five thousand four hundred eighty infants with CDH were identified, of which 4516 (82.4%) were repaired. Operative data were available in 4390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with 12 reported recurrences (7.9%) compared with 114 for open techniques (2.7%, P < .05). Minimally invasive surgery demonstrated a significant increased odds for recurrence (odds ratio, 3.59; 95% confidence interval, 1.92-6.71) after adjusting for gestational age, birth weight, patch repair, and extracorporeal membrane oxygenation.
  
  
  CONCLUSIONS
  Minimally invasive techniques appear to have a significant higher recurrent hernia rate, with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regard to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization.
authors.affiliation: Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, Houston, TX 77030, USA. kuojen.tsao@uth.tmc.edu
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lally
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
mesh_terms: D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D055502:Secondary Prevention; D015996:Survival Rate; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014481:United States