Safety of surgery for neonatal congenital diaphragmatic hernia as reflected by arterial blood gas monitoring: thoracoscopic versus open repair.
OBJECTIVE
We monitored arterial blood gases during thoracoscopic (TR) and open repair (OR) of congenital diaphragmatic hernia (CDH) to assess the safety of intraoperative hypercapnia and acidosis.


METHODS
We reviewed 30 neonatal CDH cases (OR = 10, TR = 20) diagnosed prenatally or within 6 h of birth at out institution from 2002 to 2014 not requiring inhaled nitric oxide (NO) intraoperatively. OR, routine until 2006 was replaced by TR in 2007. All subjects were managed identically.


RESULTS
Five TR cases requiring conversion to OR were excluded. Prenatal diagnosis, gestational age at birth, gender, birth weight, and side of CDH were similar. Preoperative PaCO2 and pH were not significantly different. However, while intraoperative increase in mean PaCO2 (38.8-62.8 mmHg; p < 0.01) and decrease in mean pH (7.44-7.25; p < 0.01) were significant in TR, intraoperative PaCO2 was <70 mmHg in 12/15 cases and intraoperative pH was >7.20 in 11/15 cases. Both PaCO2 and pH reverted to normal on completion of surgery; pre- and postoperative results were comparable. There were no postoperative complications.


CONCLUSIONS
It would appear that neonatal cases of CDH not requiring NO can tolerate TR, despite transient reversible deterioration in acid/base balance, indicating that TR is safe for the treatment of selected cases of CDH.
Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. okazakit@juntendo.ac.jp.
Tadaharu
T
Okazaki
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Manabu
M
Okawada
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Hiroyuki
H
Koga
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Go
G
Miyano
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Takashi
T
Doi
Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
Yuki
Y
Ogasawara
Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.|Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Yuta
Y
Yazaki
Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan.
Kinya
K
Nishimura
Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan.
Eiichi
E
Inada
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Geoffrey J
GJ
Lane
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Atsuyuki
A
Yamataka
D001784:Blood Gas Analysis / Q000379:methods*; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000097:blood* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011183:Postoperative Complications; D011247:Pregnancy; D011296:Prenatal Diagnosis; D013906:Thoracoscopy
Acidemia; Congenital diaphragmatic hernia; Hypercapnia; Thoracoscopic repair