title: Congenital diaphragmatic hernia in neonates: factors related to failure of thoracoscopic repair.
abstract: OBJECTIVE
  To evaluate factors related to conversion to open repair (OR) during thoracoscopic repair (TR) in congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  CDH subjects who were diagnosed prenatally or within 6 h of birth and underwent TR at our institution from 2007 to 2015 were reviewed. Two groups were defined: Group A, subjects who tolerated TR; and Group B, subjects who required conversion to OR.
  
  
  RESULTS
  Twenty-nine subjects (Group A, 20; Group B, 9) underwent TR. Patients' demographics were not significantly different between the two groups. In Group A, pre-operative arterial blood gas analysis showed mean PaCO2 37.4 mmHg, mean pH 7.45, and mean PaO2 201.6 mmHg, which were not significantly different from those of Group B (PaCO2 40.6 mmHg, pH 7.43, and PaO2 251.1 mmHg). Two Group B cases required conversion due to cardiopulmonary instability. The remaining seven cases were converted for technical reasons (large defect in two, anterior location of the defect in two, bleeding from short gastric vessels or spleen in two, and insufficient operative view in one).
  
  
  CONCLUSIONS
  TR can be performed safely in selected cases of CDH. CDH with a large defect and/or an unusual location of the defect remains a challenge for pediatric surgeons.
authors.affiliation: Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan. okazakit@juntendo.ac.jp.
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.affiliation: Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.affiliation: Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.affiliation: Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ogasawara
authors.affiliation: Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D001784:Blood Gas Analysis; D005260:Female; D005500:Follow-Up Studies; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D012307:Risk Factors; D013906:Thoracoscopy / Q000379:methods*; D017211:Treatment Failure
keywords: Acidemia; Congenital diaphragmatic hernia; Conversion; Hypercapnia; Thoracoscopic repair