title: Thoracoscopic plication for diaphragmatic eventration in a neonate.
abstract: BACKGROUND
  Currently, thoracoscopic surgery is replacing thoracotomy for an ever increasing number of indications, even in pediatric surgery. However, there are few reports describing thoracoscopic plication (TP) for diaphragmatic eventration in children, particularly in neonates. We report a case of TP under single-lung ventilation in a neonate with diaphragmatic eventration.
  
  
  METHODS
  A 10-day-old boy was referred for surgical management of right diaphragmatic eventration. Birth was at term, following an uncomplicated pregnancy and delivery. Shortness of breath, labored respiration and chest retraction presented soon after birth, necessitating mechanical ventilation. Chest radiography and computed tomography revealed an elevated right hemidiaphragm. Attempted weaning off mechanical ventilation failed with persistence of respiratory symptoms, requiring nasal directional positive airway pressure. However, because there was no resolution of symptoms, TP was performed using a 3 port technique under single-lung ventilation on day 17 of life. The postoperative course was excellent with complete resolution of respiratory symptoms with no recurrence for 9 months.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the youngest case of TP for diaphragmatic eventration performed under single-lung ventilation. TP is safe, effective and minimally invasive and should be considered actively for the treatment of symptomatic diaphragmatic eventration even in neonates.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. tsubasa@juntendo.ac.jp
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Takahashi
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Takanori
authors.initials: T
authors.lastname: Ochi
authors.forename: Kinya
authors.initials: K
authors.lastname: Nishimura
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Eiichi
authors.initials: E
authors.lastname: Inada
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D003965:Diaphragmatic Eventration / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D061810:One-Lung Ventilation; D011859:Radiography; D013906:Thoracoscopy; D016896:Treatment Outcome