BACKGROUND: To analyze the early outcome of thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH) with standardized indications. METHODS: Clinical data of 14 neonates with CDH who underwent TR from September 2013 to August 2014 were retrospectively analyzed. SELECTION CRITERIA: weight beyond 2.0 kg; liver in the abdomen; no intestinal obstruction; no severe cardiopulmonary anomalies; not required high-frequency oscillatory ventilation or extracorporeal membrane oxygenation. Timing of surgery: mean arterial blood pressure normal for gestational age; preductal saturation levels of 85%-95% on fractional inspired oxygen below 50%; lactate below 3 mmol/L; urine output more than 2 mL/kg/h. Fourteen cases in the historical control group who underwent open repair (OR) with the same physiological status were reviewed for comparison. RESULTS: Demographic features were similar between the TR group and OR group. The TR group had a higher intraoperative mean PaCO2 (48 ± 8 mmHg versus 39 ± 6 mmHg, P = .0024) and mean arterial pH (7.30 ± 0.06 versus 7.39 ± 0.06, P = .0005), but no differences in lactate (0.93 ± 0.16 mmol/L versus 0.98 ± 0.14 mmol/L, P = .3869). Longer operation time was found in the TR group (116 ± 27 minutes versus 74 ± 25 minutes, P = .0002). No recurrence was observed in groups within the first year of life follow-up. CONCLUSIONS: With selection criteria and timing, TR of CDH in neonates can be performed safely and successfully.
BACKGROUND: To analyze the early outcome of thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH) with standardized indications. METHODS: Clinical data of 14 neonates with CDH who underwent TR from September 2013 to August 2014 were retrospectively analyzed. SELECTION CRITERIA: weight beyond 2.0 kg; liver in the abdomen; no intestinal obstruction; no severe cardiopulmonary anomalies; not required high-frequency oscillatory ventilation or extracorporeal membrane oxygenation. Timing of surgery: mean arterial blood pressure normal for gestational age; preductal saturation levels of 85%-95% on fractional inspired oxygen below 50%; lactate below 3 mmol/L; urine output more than 2 mL/kg/h. Fourteen cases in the historical control group who underwent open repair (OR) with the same physiological status were reviewed for comparison. RESULTS: Demographic features were similar between the TR group and OR group. The TR group had a higher intraoperative mean PaCO2 (48 ± 8 mmHg versus 39 ± 6 mmHg, P = .0024) and mean arterial pH (7.30 ± 0.06 versus 7.39 ± 0.06, P = .0005), but no differences in lactate (0.93 ± 0.16 mmol/L versus 0.98 ± 0.14 mmol/L, P = .3869). Longer operation time was found in the TR group (116 ± 27 minutes versus 74 ± 25 minutes, P = .0002). No recurrence was observed in groups within the first year of life follow-up. CONCLUSIONS: With selection criteria and timing, TR of CDH in neonates can be performed safely and successfully.
Authors: Laurens D Eeftinck Schattenkerk; Gijsbert D Musters; David J Nijssen; Wouter J de Jonge; Ralph de Vries; L W Ernest van Heurn; Joep P M Derikx Journal: Innov Surg Sci Date: 2021-08-17