A comparative study of thoracoscopic and open surgery of congenital diaphragmatic hernia in neonates

Abstract

Background: An increasing number of hospitals have carried out neonatal thoracoscopic assisted repair of congenital diaphragmatic hernia (CDH).

Methods: The 26 cases received thoracoscopic-assisted repair (observation group) and 44 cases open repair (control group). General anesthesia was performed with endotracheal intubation using a trachea cannula without cuff. The general preoperative data, intraoperative hemodynamic parameters, intraoperative surgical conditions, postoperative complications, postoperative recovery condition, postoperative survival rate and recurrence rate were recorded.

Results: The intraoperative mean arterial pressure and heart rate at each time point in observation group were more stable and effective than those in control group (all P < 0.001). The number of manual ventilation, SpO₂ < 90% and hypercapnia cases were significantly lower than those in control group (all P < 0.05). Intraoperative bleeding, incision length and operation duration were significantly lower in observation group compared with control group (all P < 0.001). No significant differences were seen between the two groups in postoperative complications including pulmonary infection, incision infection, pulmonary hypertension, hemorrhage, and scleredema (all P > 0.05). The duration of postoperative mechanical ventilation, antibiotic use and hospitalization in observation group was significantly shorter than those in control group (all P < 0.05). There was no significant difference in postoperative survival rate and recurrence rate between the two groups (both P > 0.05).

Conclusion: The intraoperative hemodynamic parameters of CDH repair under thoracoscopy were more stable, the duration of postoperative mechanical ventilation, antibiotic use and hospitalization were shortened, and the therapeutic effect was better.

Keywords: Congenital diaphragmatic hernia; Neonates anesthesia; Open surgery; Thoracoscopy.

Fig. 1

Intraoperative hemodynamic changes in HR (a) and MAP (b). ^aP < 0.001, compared within the same group after induction; ^bP < 0.001, compared with observation group. T0, pre-induction; T1, post-induction; T2 T3, T4 and T5 indicated 1 min, 10 min, 60 min and 120 min after surgery, respectively; CON, control; HR, heart rate; MAP, mean arterial pressure