title: Thoracoscopic repair of recurrent bochdalek diaphragmatic hernias in children.
abstract: BACKGROUND
  Recurrent herniation is a well-known complication following the initial repair of congenital diaphragmatic hernias (CDHs). The role of minimally invasive surgical techniques in recurrent CDH remains undefined. The purpose of this study was to evaluate our early experience with thoracoscopic repair compared with traditional open repair in children with recurrent CDH.
  
  
  METHODS
  We retrospectively reviewed all recurrent Bochdalek CDH cases (n=24) managed at a single tertiary-care referral center between January 1990 and March 2011. Children who underwent thoracoscopic repair for recurrent CDH were identified, and their data were compared by the unpaired t test and the two-sided Fisher's exact test, as appropriate, with those of children who underwent open repair. Significance was defined as P<.05.
  
  
  RESULTS
  Thoracoscopic repair was attempted in 6 (25%) children with recurrent CDH. Four (67%) repairs were successfully completed without conversion to an open procedure. The mean age at thoracoscopic repair was 11.5 months (range, 8.1-16.1 months). The mean operative time was 191 minutes (range, 94-296 minutes), and all children were extubated within 24 hours. The mean hospital length of stay was 3.75 days (range, 1-6 days). There were no deaths or subsequent recurrences after a mean follow-up of 26.5 months (range, 14.3-41.3 months). There were no statistical differences in any of the measured outcome variables when compared with the open repair group.
  
  
  CONCLUSIONS
  Our initial experience suggests that thoracoscopic repair is a feasible alternative to open repair in selected children with recurrent Bochdalek diaphragmatic hernias.
authors: Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System , C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA. shaunkun@umich.edu
authors: Shaun M
authors: SM
authors: Kunisaki
authors: Ian A
authors: IA
authors: Powelson
authors: Steven W
authors: SW
authors: Bruch
authors: Marcus D
authors: MD
authors: Jarboe
authors: James D
authors: JD
authors: Geiger
authors: George B
authors: GB
authors: Mychaliska
mesh_terms: D002648:Child; D002675:Child, Preschool; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012008:Recurrence; D012189:Retrospective Studies; D013906:Thoracoscopy