title: Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates.
abstract: OBJECTIVE
  Publications aiming to prove the feasibility and safety of thoracoscopic CDH-repair in neonates grow in numbers. Some teams use selection criteria, but none have proven statistical evidence. The aim of this study is to detect risk factors for failure of thoracoscopic primary closure of CDH in neonates.
  
  
  METHODS
  In 8 centers performing minimal access surgery (MAS), complete prenatal, postnatal, and operative data were evaluated for a retrospective study concerning patients with thoracoscopic congenital diaphragmatic hernia (CDH) repair. Most of the selection criteria and risk factors mentioned in the literature were analyzed. Two groups were defined: Group A - neonates who tolerated thoracoscopic primary repair, and Group B - neonates who required conversion or presented with major complications after thoracoscopic repair. Univariate and multivariate logistic regressions were used to compare these two groups.
  
  
  RESULTS
  From 2006 to 2010, thoracoscopy was performed in 40 neonates: Group A consisting of 28 neonates, and Group B 9 patients. Three patients were excluded because of insufficient data or major associated malformations. Significant statistical differences were found in Group B for postnatal PaCO2 >60 mmHg, need of iNO during postnatal stabilization, intrathoracic position of the stomach, pulmonary hypertension signs on the postnatal cardiac ultrasound, and preoperative OI >3.0. On multivariate analysis, only an OI >3.0 was significantly associated with conversion or major post-operative complication of thoracoscopic primary repair.
  
  
  CONCLUSIONS
  CDH can be safely repaired in the neonatal period by thoracoscopy. The limiting factor for thoracoscopic CDH repair is PPHN. The best preoperative indicator for PPHN is OI. Prospective studies are nonetheless necessary to prove the effectiveness of using these risk factors as selection criteria to help design surgical management protocols for neonates presenting CDH.
authors.affiliation: Department of Pediatric Surgery of the University Hospitals, Strasbourg, France. gomes.cindy@chl.lu
authors.forename: Cindy
authors.initials: C
authors.lastname: Gomes Ferreira
authors.forename: Pierre
authors.initials: P
authors.lastname: Kuhn
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lacreuse
authors.forename: Christos
authors.initials: C
authors.lastname: Kasleas
authors.forename: Paul
authors.initials: P
authors.lastname: Philippe
authors.forename: Guillaume
authors.initials: G
authors.lastname: Podevin
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
authors.forename: Pascal
authors.initials: P
authors.lastname: De Lagausie
authors.forename: Thierry
authors.initials: T
authors.lastname: Petit
authors.forename: Hubert
authors.initials: H
authors.lastname: Lardy
authors.forename: François
authors.initials: F
authors.lastname: Becmeur
mesh_terms: D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013906:Thoracoscopy / Q000009:adverse effects; D017211:Treatment Failure