Early experience with thoracoscopic repair of congenital diaphragmatic hernias in pediatric age group: results and lessons learned

Abstract

Purpose: To describe the surgical technique, initial results, and overview indications of thoracoscopic repair of congenital diaphragmatic hernia.

Patients and methods: A retrospective review was undertaken of patients with CDH who underwent thoracoscopic repair from January 2006 to July 2010, in department of pediatric surgery in a tertiary care institute in India. Patients underwent surgery under general anesthesia. Reduction of the hernia contents was carried out using one trocar for telescope and two operating trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 6-10 mmHg. The hernia defect was repaired using nonabsorbable interrupted sutures.

Results: There were 17 patients, including 12 boys and 5 girls. Among 12 infants, there were 6 patients younger than 30 days. The other 5 patients were older than 1 year. The hernia was located in the left side in 14 patients and in the right side in 3 patients. The mean operative time was 110 min. Conversion was required in three patients. There were one recurrence and one postoperative death.

Conclusions: Thoracoscopic repair is feasible and safe for children with CDH, including selective newborn. The technique causes minimal trauma, results in good respiratory function, and promotes early recovery.