A Multi-Institutional Review of Thoracoscopic Congenital Diaphragmatic Hernia Repair.
BACKGROUND
Thoracoscopic repair of a congenital diaphragmatic hernia (CDH) in the neonate is controversial due to reports of increased hernia recurrence. A multicenter review on thoracoscopic CDH repair was conducted to evaluate outcomes and to identify factors that are associated with recurrence.


METHODS
A multicenter retrospective review was conducted from 2009 to 2015 in neonates who were treated for CDH with thoracoscopic repair. Demographics, preoperative, intraoperative, including repair techniques, and postoperative variables were analyzed by using descriptive statistics. Comparative analysis was performed between those patients who were repaired entirely thoracoscopically with hernia recurrence and those without.


RESULTS
One hundred nine infants, of whom 57% were male with an average gestational age at time of surgery of 39.6 ± 4.6 weeks and a weight of 3.4 ± 1.1 kg, were included. The median age at repair was 5 days (range: 3-9), 61% patients required vasopressor support, and 1.8% patients required extracorporeal membrane oxygenation (ECMO) cannulation before repair. Forty-five percent were repaired on high-frequency oscillatory ventilation (HFOV). Repair was completed thoracoscopically in 83 patients (76%), 68 (82%) were repaired primarily, 15 (18%) were repaired with a patch, and 50 (60%) had extracorporeal/rib fixation sutures. Recurrence occurred in 7 (8.4%) of those completed thoracoscopically. Factors found to be significant for recurrence included: vasopressor therapy (P = .02), repair on HFOV (P = .04), and the presence of the spleen in the chest (P = .04). There was no significant difference identified between technical variations in repair.


CONCLUSIONS
These data suggest that thoracoscopic repair of CDH is feasible in carefully selected patients. However, there is currently no evidence to support a standardized surgical approach to thoracoscopic repair.
1 Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
Katrina L
KL
Weaver
2 Department of Pediatric Surgery, Loma Linda University Children's Hospital , Loma Linda, California.
Joanne E
JE
Baerg
3 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine , Tokyo, Japan .
Manabu
M
Okawada
3 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine , Tokyo, Japan .
Go
G
Miyano
4 Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.
Katherine A
KA
Barsness
5 Center of Pediatric Surgery , Hanover Medical School, Hannover, Germany .
Martin
M
Lacher
6 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.
Dani O
DO
Gonzalez
6 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio.
Peter C
PC
Minneci
7 Division of Pediatric Surgery, McLane Children's Hospital at Scott and White , Texas A&M College of Medicine, Temple, Texas.
Lena
L
Perger
1 Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri.
Shawn D
SD
St Peter
D001724:Birth Weight; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents
congenital diaphragmatic hernia; repair; thoracoscopy