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Technical trick for diaphragmatic plication in congenital diaphragmatic eventrations: the clamp

Jean François Lecompte, Geraldine Hery, Pascal de Lagausie

Hopital Timone, Marseille, France



Background: Congenital diaphragmatic eventration needs a plication when it has an impact on respiratory function. During the last 10 years it’s done by thoracoscopy for reducing the surgical morbidity. Since then new tricks are surch to reach the best flattening of the diaphragm. We report 5 cases of plication using vascular clamp as technical tricks.
Material and Method: 5 patients, 1 girl and 4 boys, from 1 day to 15 months underwent thorascopic diaphragmatic plication for congenital diaphragmatic eventration. Selective ventilation was performed for 3 cases, and bipulmonary ventilation for 2 cases. A low insufflation allowed lung collapse. Diaphragmatic plication was done with four 5mm ports. The diaphragm was pinched by a clamp, introduced in the more distal ports hole, up to its base and complete abdominal viscera reintegration. A first hand-sew U-stitches suture was done at the base. Endostapler sac resection was done if the sac was too big. Then the sac was pulled and fixed in the lateral recess. A chest drain was placed at the end of the procedure.
Results: 2 had a sac resection with endostapler. The 5 were extubated immediately after surgery. Chest drains were removed between the 2nd and the 6th post-operative day. No additional thoracic surgery was needed. Chest radiographs showed good flattening of the diaphragm.
Conclusion: The clamp was good trick to facilitate diaphragmatic plication with a good tension and no additional surgery, even in newborns.