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Surgical Endoscopy

, Volume 31, Issue 8, pp 3320–3325 | Cite as

Technical standardization of laparoscopic repair of Morgagni diaphragmatic hernia in children: results of a multicentric survey on 43 patients

  • Ciro Esposito
  • Maria Escolino
  • Francois Varlet
  • Amulya Saxena
  • Sabine Irtan
  • Paul Philippe
  • Alessandro Settimi
  • Mariapina Cerulo
  • Holger Till
  • Francois Becmeur
  • George W. HolcombIII
Article

Abstract

Background

This study aimed to standardize the surgical correction technique of congenital Morgagni diaphragmatic hernia (CMDH), analyzing the results of an international multicentric survey.

Methods

The medical records of 43 patients (29 boys, 14 girls) who underwent laparoscopic repair of CMDH in 8 pediatric surgery units in a 5-year period were retrospectively reviewed. Their average age was 3.3 years. Ten patients (23.2%) presented associated malformations: 9 Down syndrome (20.9%) and 1 palate cleft (2.3%). Thirty-five patients (81.4%) were asymptomatic, whereas 8 patients (18.6%) presented symptoms such as respiratory distress, cough or abdominal pain. As for preoperative work-up, all patients received a chest X-ray (100%), 15/43 (34.8%) a CT scan, 8/43 (18.6%) a barium enema and 4/43 (9.3%) a US.

Results

No conversion to open surgery was reported. Average operative time was 61.2 min (range 45–110 min). In 38/43 (88.3%) patients, a trans-parietal stitch was positioned in order to reduce the tension during the repair. In 14/43 cases (32.5%), the sac was resected; in only 1/43 case (2.3%) a dual mesh of goretex was adopted to reinforce the closure. Average hospital stay was 2.8 days. The average follow-up was 4.2 years, and it consisted in annual clinical controls and chest X-ray. We recorded 2 complications (4.6%): one small pleural opening that required no drain and one recurrence (2.3%), re-operated in laparoscopy, with no further recurrence.

Conclusions

To the best of our knowledge, this is the largest series published in the literature on this topic. Laparoscopic CMDH repair is well standardized: The full-thickness anterior abdominal wall repair using non-resorbable suture with interrupted stitches is the technique of choice. Postoperative outcome was excellent. Recurrence rate was very low, about 2% in our series. We believe that children with CMDH should be always treated in laparoscopy following the technical details reported in this paper.

Keywords

Morgagni diaphragmatic hernia Surgical technique Children Laparoscopy 

Notes

Compliance with ethical standards

Disclosures

Ciro Esposito, Maria Escolino, Francois Varlet, Amulya Saxena, Sabine Irtan, Paul Philippe, Alessandro Settimi, Mariapina Cerulo, Holger Till, Francois Becmeur and George W. Holcomb 3rd have no conflict of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ciro Esposito
    • 1
  • Maria Escolino
    • 1
  • Francois Varlet
    • 2
  • Amulya Saxena
    • 3
  • Sabine Irtan
    • 4
  • Paul Philippe
    • 5
  • Alessandro Settimi
    • 1
  • Mariapina Cerulo
    • 1
  • Holger Till
    • 6
  • Francois Becmeur
    • 7
  • George W. HolcombIII
    • 8
  1. 1.Department of Translational Medical Sciences“Federico II” University of NaplesNaplesItaly
  2. 2.Department of Pediatric Surgery, Nord HospitalUniversity Medical CenterSaint-EtienneFrance
  3. 3.Department of Pediatric SurgeryChelsea Children HospitalLondonUK
  4. 4.Department of Pediatric SurgeryAPHP Hôpital Armand TrousseauParisFrance
  5. 5.Department of Pediatric Surgery, Pediatric ClinicCentre Hospitalier de LuxembourgLuxembourgLuxembourg
  6. 6.Department of Pediatric and Adolescent SurgeryMedical University of GrazGrazAustria
  7. 7.Department of Pediatric SurgeryHôpitaux Universitaires de StrasbourgStrasbourgFrance
  8. 8.Department of SurgeryChildren’s Mercy HospitalKansas CityUSA

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