title: Surgical intervention for congenital diaphragmatic hernia: open versus thoracoscopic surgery.
abstract: OBJECTIVE
  To compare open repair (OR) with thoracoscopic repair (TR) for congenital diaphragmatic hernia (CDH) in neonates.
  
  
  METHODS
  Twenty-four neonatal CDH cases diagnosed prenatally or within 6 h of birth at our institute from 2002 to 2012 with mild pulmonary hypertension managed without inhaled nitric oxide, were studied. OR was routine until 2006 (n = 14; L:R = 12:2) and TR became routine in 2007 (n = 10; L:R = 10:0). All subjects had identical management.
  
  
  RESULTS
  Gestational age at birth: OR 37.4 ± 1.6 vs. TR: 38.3 ± 1.1 weeks (p = 0.10); birth weight 2,636 ± 490 vs. 2,887 ± 429 grams (p = 0.20); preoperative A-aDO(2): 308 ± 200 vs. 331 ± 195 mmHg (p = 0.79); and operating time (min): 161 ± 42 vs. 194 ± 76 (p = 0.27). In TR, intraoperative cardiopulmonary status was stable, intraoperative hemorrhage was significantly less (4.8 ± 6.0 vs. 1.1 ± 0.1 grams; p = 0.038), wound cosmesis was excellent without surgical site infections, while, maximum postoperative CRP (2.0 ± 1.5 vs. 1.5 ± 1.1 mg/dL; p = 0.30), commencement of enteral feeding (6.9 ± 2.8 vs. 5.6 ± 2.8 days; p = 0.27), and length of postoperative hospitalization (36 ± 22 vs. 34 ± 12 days; p = 0.66) were improved, but not significantly. One OR case required surgery for intestinal obstruction.
  
  
  CONCLUSIONS
  Thoracoscopic repair appears to be as effective as OR for treating selected cases of CDH in neonates, with excellent wound cosmesis.
authors: Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
authors: Takaaki
authors: T
authors: Tanaka
authors: Tadaharu
authors: T
authors: Okazaki
authors: Yumi
authors: Y
authors: Fukatsu
authors: Manabu
authors: M
authors: Okawada
authors: Hiroyuki
authors: H
authors: Koga
authors: Go
authors: G
authors: Miyano
authors: Yuki
authors: Y
authors: Ogasawara
authors: Geoffrey J
authors: GJ
authors: Lane
authors: Atsuyuki
authors: A
authors: Yamataka
mesh_terms: D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000639:trends; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome
references: Ann Thorac Surg. 1995 Aug;60(2):448-50
references: 7646117
references: Surg Endosc. 1995 Sep;9(9):1001-3
references: 7482203
references: J Pediatr Surg. 2010 Feb;45(2):355-9
references: 20152351
references: J Pediatr Surg. 2011 Mar;46(3):458-61
references: 21376192
references: Pediatr Surg Int. 2012 Sep;28(9):883-6
references: 22875462
references: Pediatr Surg Int. 2008 Dec;24(12):1369-73
references: 18985361
references: Pediatr Surg Int. 2006 Nov;22(11):925-30
references: 16969680
references: J Pediatr Surg. 2003 Nov;38(11):1563-8
references: 14614701
references: J Pediatr Surg. 2011 Jun;46(6):1158-64
references: 21683215
references: J Pediatr Surg. 2009 Jan;44(1):80-6; discussion 86
references: 19159722
references: Pediatr Surg Int. 2011 Jan;27(1):35-8
references: 20852868
references: Br J Anaesth. 2006 Aug;97(2):215-9
references: 16720671
references: J Pediatr Surg. 2009 Sep;44(9):1702-7
references: 19735811
references: J Pediatr Surg. 2011 Jul;46(7):1303-8
references: 21763826