Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Lessons Learned

作者：Anne C. Kim, Benjamin S. Bryner, Begum Akay, James D. Geiger, Ronald B. Hirschl, George B. Mychaliska · 发表于：Journal of Laparoendoscopic & Advanced Surgical Techniques · 年份：2009 · DOI：10.1089/lap.2009.0129 · 被引用次数：48 · 研究领域：Congenital Diaphragmatic Hernia Studies、Pleural and Pulmonary Diseases、Tracheal and airway disorders

PURPOSE: We sought to characterize our recent experience with thoracoscopic congenital diaphragmatic hernia (CDH) repair and identify patient selection factors. METHODS: We reviewed the medical records of full-term neonatal (<1 month of age) patients who underwent thoracoscopic CDH repair between 2004 and 2008 (n = 15). We obtained data on prenatal diagnosis, characteristics of the CDH and repair, complications, and outcome. RESULTS: All patients were stabilized preoperatively and underwent repair at an average of 5.7 +/- 1.3 days. Six patients were prenatally diagnosed, including the 5 inborn. Thirteen defects were left-sided. All were intubated shortly after birth and 2 required extracorporeal membrane oxygenation (ECMO). Twelve of 15 (80%) patients underwent successful thoracoscopic primary repair, including 1 of the patients who required ECMO prior to repair. Conversion to open repair occurred in 3 of 15 (20%) patients because of the need for patch closure or intraoperative instability. Among those converted to open, all had left-sided CDH defects and 3 had stomach herniation (of 5 such patients). Patients spent an average of 6.9 +/- 1.0 days on the ventilator following repair. The average time until full-enteral feeding was 16.7 +/- 2.25 days, and average length of hospital stay was 23.8 +/- 2.73 days. All patients survived to discharge, and average length of follow-up was 15.3 +/- 3.6 months. CONCLUSIONS: Thoracoscopic repair of CDH is a safe, effective strategy in pati...