title: Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study.
abstract: BACKGROUND
  Experience in thoracoscopic congenital diaphragmatic hernia (CDH) repair has expanded, yet efficacy equal to that of open repair has not been demonstrated. In spite of reports suggesting higher recurrent hernia rates after thoracoscopic repair, this approach has widely been adopted into practice. We report a large, single institutional experience with thoracoscopic CDH repair with special attention to recurrent hernia rates.
  
  
  METHODS
  We reviewed the records of neonates with unilateral CDH repaired between January 2006 and February 2010 at Morgan Stanley Children's Hospital. Completely thoracoscopic repairs were compared to open repairs of the same period. In addition, successful thoracoscopic repairs were compared with thoracoscopic repairs that developed recurrence. Data were analyzed by Mann-Whitney U and Fisher exact tests.
  
  
  RESULTS
  Thirty-five neonates underwent attempted thoracoscopic repair, with 26 completed. Concurrently, 19 initially open CDH repairs were performed. Preoperatively, patients in the open repair group required more ventilatory support than the thoracoscopic group. Recurrence was higher after thoracoscopic repair (23% vs 0%; P = .032). In comparing successful thoracoscopic repairs to those with recurrence, none of the factors analyzed were predictive of recurrence.
  
  
  CONCLUSIONS
  Early recurrence of hernia is higher in thoracoscopic CDH repairs than in open repairs. Technical factors and a steep learning curve for thoracoscopy may account for the higher recurrence rates, but not patient severity of illness. In an already-tenuous patient population, performing the repair thoracoscopically with a higher risk of recurrence may not be advantageous.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY 10032, USA. jwg2107@columbia.edu
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Gander
authors.forename: Jason C
authors.initials: JC
authors.lastname: Fisher
authors.forename: Erica R
authors.initials: ER
authors.lastname: Gross
authors.forename: Ari R
authors.initials: AR
authors.lastname: Reichstein
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cowles
authors.forename: Gudrun
authors.initials: G
authors.lastname: Aspelund
authors.forename: Charles J H
authors.initials: CJ
authors.lastname: Stolar
authors.forename: Keith A
authors.initials: KA
authors.lastname: Kuenzler
mesh_terms: D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D059032:Learning Curve; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D012008:Recurrence; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D019616:Thoracic Surgical Procedures; D013906:Thoracoscopy / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome