title: Diaphragmatic eventration in children: laparoscopy versus thoracoscopic plication.
abstract: OBJECTIVE
  To determine the best way to perform diaphragmatic plication for diaphragmatic eventration (DE) using minimally invasive surgery.
  
  
  METHODS
  We conducted a retrospective review of pediatric cases of DE treated between 2007 and 2012. Thoracoscopic plication (TP) is performed using single-lung ventilation with three 5-mm ports; laparoscopic plication (LP) is performed using three or four 5-mm ports. The choice of technique was determined preferentially by the treating surgeon.
  
  
  RESULTS
  There were 20 subjects (13 treated by LP and 7 treated by TP). Etiology of DE was phrenic nerve injury (LP, n=11; TP, n=1) and muscular deficiency (LP, n=2; TP, n=6). Mean age (LP, 18 months; TP, 25 months) and weight (LP, 8.0 kg; TP, 9.7 kg) at surgery were not significantly different. Mean operating time was 155.6 minutes in LP and 167.0 minutes in TP (P=not significant). Mean intraoperative end-tidal CO2 was 41.9 mm Hg (range, 35-52 mm Hg) in LP and 36.9 mm Hg (range, 33-41 mm Hg) in TP (P=.01). Mean duration of postoperative ventilation was 1.2 days in LP and 1.3 days in TP (P=not significant). Mean time taken to recommence feeding postoperatively was 1.6 days in both groups (P=not significant). Complications were one conversion to thoracotomy in TP, 1 case of atelectasis in each group (P=not significant), and 6 cases of recurrence in LP versus none in TP (P=.04).
  
  
  CONCLUSIONS
  Both TP and LP are beneficial for treating small children with DE. However, there is a higher incidence of recurrence after LP, and the role of TP in cardiac patients requiring subsequent surgery is debatable.
authors.affiliation: 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan .
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamoto
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Kaneshiro
authors.forename: Hiromu
authors.initials: H
authors.lastname: Miyake
authors.forename: Keiichi
authors.initials: K
authors.lastname: Morita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nouso
authors.forename: Mariko
authors.initials: M
authors.lastname: Koyama
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Koji
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Naoto
authors.initials: N
authors.lastname: Urushihara
mesh_terms: D002648:Child; D002675:Child, Preschool; D003965:Diaphragmatic Eventration / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome