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Thoracoscopic management of congenital diaphragmatic hernia: single center experience

Antoine Liné, Francis Lefebvre, Aurélien Binet, Caroline François-Fiquet, Marie-Laurence Poli-Mérol

Department of Pediatric Surgery, American Memorial Hospital, Reims, France

 

Abstract 

Introduction: Minimally invasive surgery is more used in pediatric surgery and thoracoscopy is now the popular management of congenital diaphragmatic hernia. Closing method (diaphragmatic plication, suture, patch repair) is dependant of operative constatations. Necessary learning for new technical method is difficult especially as pathology is rare. We made the choice to evaluate our results, after 4 years experience.
Materials and methods: Retrospective study: 11 children (4 girls, 7 boys) with congenital diaphragmatic hernia (9 left, 2 right) managed by thoracoscopy since 2009. Perinatal and surgical data, comparison with anterior group managed by laparotomy and review of the literature.
Results: On arterial blood gases, acid pH was 7,18 and pCO2 was 68,4 mmHg. Length of intubation was 16 days (High Frequency Ocillation during 7 days, Synchronised Intermittent Mandatory Ventilation during 9 days). 7 children received exogenous surfactant, 9 received NO (during 16 days). Length of hospitalization in reanimatory ward was 30 days. 7 children were managed by direct suture and 4 had patch repair (Gore-Tex®). We noted 3 recurrence: 2 with patch and 1 suture. We also had 2 surgical management for occlusive syndrome.
Conclusion: In comparison to our anterior experience, thoracoscopic management of congenital diaphragmatic hernia led to more surgical complications, specially recurrence. However, mortality and length of hospitalization didn’t increase. We emphazise difficulties and our choice to manage by thoracoscopy this children