Advertisement

Surgery Today

, Volume 46, Issue 7, pp 757–763 | Cite as

Minimally invasive surgery for diaphragmatic diseases in neonates and infants

  • Jun FujishiroEmail author
  • Tetsuya Ishimaru
  • Masahiko Sugiyama
  • Mari Arai
  • Keisuke Suzuki
  • Hiroshi Kawashima
  • Tadashi Iwanaka
Review Article

Abstract

Owing to recent advances in minimally invasive surgery (MIS), laparoscopic and thoracoscopic surgery have been gradually introduced for use in neonates and infants. This review focuses on two popular MIS procedures for diaphragmatic diseases in neonates and infants: congenital diaphragmatic hernia (CHD) repair and plication for diaphragmatic eventration. While several advantages of MIS are proposed for CDH repair in neonates, there are also some concerns, namely intraoperative hypercapnia and acidosis and a higher recurrence rate than open techniques. Thus, neonates with severe CDH, along with an unstable circulatory and respiratory status, may be unsuitable for MIS repair, and the use of selection criteria is, therefore, important in these patients. It is generally believed that a learning curve is associated with the higher recurrence rate. Contrary to CDH repair, no major disadvantages associated with the use of MIS for diaphragmatic eventration have been reported in the literature, other than technical difficulty. Thus, if technically feasible, all pediatric patients with diaphragmatic eventration requiring surgical treatment are potential candidates for MIS. Due to a shortage of studies on this procedure, the potential advantages of MIS compared to open techniques for diaphragmatic eventration, such as early recovery and more rapid extubation, need to be confirmed by further studies.

Keywords

Minimally invasive surgery Congenital diaphragmatic hernia Diaphragmatic eventration Thoracoscopic surgery 

References

  1. 1.
    Li B, Chen WB, Wang SQ, et al. Laparoscopic diagnosis and treatment of neonates with duodenal obstruction associated with an annular pancreas: report of 11 cases. Surg Today. 2015;45:17–21.CrossRefPubMedGoogle Scholar
  2. 2.
    Li B, Chen WB, Wang SQ, et al. Single-site umbilical laparoscopic pyloromyotomy in neonates less than 21-day old. Surg Today. 2015;45:29–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Silen ML, Canvasser DA, Kurkchubasche AG, et al. Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia. Ann Thorac Surg. 1995;60:448–50.CrossRefPubMedGoogle Scholar
  4. 4.
    van der Zee DC, Bax NM. Laparoscopic repair of congenital diaphragmatic hernia in a 6-month-old child. Surg Endosc. 1995;9:1001–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Shah AV, Shah AA. Laparoscopic approach to surgical management of congenital diaphragmatic hernia in the newborn. J Pediatr Surg. 2002;37:548–50.PubMedGoogle Scholar
  6. 6.
    Arca MJ, Barnhart DC, Lelli JL Jr, et al. Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg. 2003;38:1563–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Ferreira CG, Reinberg O, Becmeur F, et al. Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy. Surg Endosc. 2009;23:1650–9.CrossRefGoogle Scholar
  8. 8.
    Yang EY, Allmendinger N, Johnson SM, et al. Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome. J Pediatr Surg. 2005;40:1369–75.CrossRefPubMedGoogle Scholar
  9. 9.
    Tsao K, Lally PA, Lally KP. Minimally invasive repair of congenital diaphragmatic hernia. J Pediatr Surg. 2011;46:1158–64.CrossRefPubMedGoogle Scholar
  10. 10.
    Szavay PO, Obermayr F, Maas C, et al. Perioperative outcome of patients with congenital diaphragmatic hernia undergoing open versus minimally invasive surgery. J Laparoendosc Adv Surg Tech A. 2012;22:285–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Becmeur F, Reinberg O, Dimitriu C, et al. Thoracoscopic repair of congenital diaphragmatic hernia in children. Semin Pediatr Surg. 2007;16:238–44.CrossRefPubMedGoogle Scholar
  12. 12.
    Gourlay DM, Cassidy LD, Sato TT, et al. Beyond feasibility: a comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias. J Pediatr Surg. 2009;44:1702–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Keijzer R, van de Ven C, Vlot J, et al. Thoracoscopic repair in congenital diaphragmatic hernia: patching is safe and reduces the recurrence rate. J Pediatr Surg. 2010;45:953–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Okazaki T, Nishimura K, Takahashi T, et al. Indications for thoracoscopic repair of congenital diaphragmatic hernia in neonates. Pediatr Surg Int. 2011;27:35–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Marhuenda C, Guillen G, Sanchez B, et al. Endoscopic repair of late-presenting Morgagni and Bochdalek hernia in children: case report and review of the literature. J Laparoendosc Adv Surg Tech A. 2009;19(Suppl 1):S95–101.CrossRefPubMedGoogle Scholar
  16. 16.
    Bliss D, Matar M, Krishnaswami S. Should intraoperative hypercapnea or hypercarbia raise concern in neonates undergoing thoracoscopic repair of diaphragmatic hernia of Bochdalek? J Laparoendosc Adv Surg Tech A. 2009;19(Suppl 1):S55–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Fishman JR, Blackburn SC, Jones NJ, et al. Does thoracoscopic congenital diaphragmatic hernia repair cause a significant intraoperative acidosis when compared to an open abdominal approach? J Pediatr Surg. 2011;46:458–61.CrossRefPubMedGoogle Scholar
  18. 18.
    McHoney M, Giacomello L, Nah SA, et al. Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence. J Pediatr Surg. 2010;45:355–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Bishay M, Giacomello L, Retrosi G, et al. Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants. J Pediatr Surg. 2011;46:47–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Bishay M, Giacomello L, Retrosi G, et al. Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg. 2013;258:895–900.CrossRefPubMedGoogle Scholar
  21. 21.
    Mortellaro VE, Fike FB, Adibe OO, et al. The use of high-frequency oscillating ventilation to facilitate stability during neonatal thoracoscopic operations. J Laparoendosc Adv Surg Tech A. 2011;21:877–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Tanaka T, Okazaki T, Fukatsu Y, et al. Surgical intervention for congenital diaphragmatic hernia: open versus thoracoscopic surgery. Pediatr Surg Int. 2013;29:1183–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Gander JW, Fisher JC, Gross ER, et al. Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study. J Pediatr Surg. 2011;46:1303–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Abraham MK, Viswanath N, Ramakrishnan P, et al. Intravesical pressure: a new prognostic indicator in congenital diaphragmatic hernia. J Indian Assoc Pediatr Surg. 2011;16:129–31.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Dingemann C, Ure B, Dingemann J. Thoracoscopic procedures in pediatric surgery: what is the evidence? Eur J Pediatr Surg. 2014;24:14–9.PubMedGoogle Scholar
  26. 26.
    Lansdale N, Alam S, Losty PD, et al. Neonatal endosurgical congenital diaphragmatic hernia repair: a systematic review and meta-analysis. Ann Surg. 2010;252:20–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Vijfhuize S, Deden AC, Costerus SA, et al. Minimal access surgery for repair of congenital diaphragmatic hernia: is it advantageous?—An open review. Eur J Pediatr Surg. 2012;22:364–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Liem NT, Nhat LQ, Tuan TM, et al. Thoracoscopic repair for congenital diaphragmatic hernia: experience with 139 cases. J Laparoendosc Adv Surg Tech A. 2011;21:267–70.CrossRefPubMedGoogle Scholar
  29. 29.
    Jancelewicz T, Langer JC, Chiang M, et al. Thoracoscopic repair of neonatal congenital diaphragmatic hernia (CDH): outcomes after a systematic quality improvement process. J Pediatr Surg. 2013;48:321–5 (discussion 325).CrossRefPubMedGoogle Scholar
  30. 30.
    Cho SD, Krishnaswami S, McKee JC, et al. Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls. J Pediatr Surg. 2009;44:80–6 (discussion 86).CrossRefPubMedGoogle Scholar
  31. 31.
    Ueda K, Hayashi M, Tanaka T, et al. Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg. 2013;44:225–9 (discussion 229).CrossRefPubMedGoogle Scholar
  32. 32.
    Bielinska M, Jay PY, Erlich JM, et al. Molecular genetics of congenital diaphragmatic defects. Ann Med. 2007;39:261–74.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    de Vries TS, Koens BL, Vos A. Surgical treatment of diaphragmatic eventration caused by phrenic nerve injury in the newborn. J Pediatr Surg. 1998;33:602–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Borruto FA, Ferreira CG, Kaselas C, et al. Thoracoscopic treatment of congenital diaphragmatic eventration in children: lessons learned after 15 years of experience. Eur J Pediatr Surg. 2014;24:328–31.PubMedGoogle Scholar
  35. 35.
    Guvenc BH, Korkmaz M, Avtan L, et al. Thoracoscopic diaphragm plication in children and indications for conversion to open thoracotomy. J Laparoendosc Adv Surg Tech A. 2004;14:302–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Hines MH. Video-assisted diaphragm plication in children. Ann Thorac Surg. 2003;76:234–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Tanaka Y, Iwanaka T. Thoracoscopic diaphragmatic plication in small infants. Asian J Endosc Surg. 2011;3:169–73.CrossRefGoogle Scholar
  38. 38.
    Fujishiro J, Ishimaru T, Sugiyama M, et al. Thoracoscopic plication for diaphragmatic eventration after surgery for congenital heart disease in children. J Laparoendosc Adv Surg Tech A. 2014;25:348–51.CrossRefPubMedGoogle Scholar
  39. 39.
    Lao VV, Lao OB, Abdessalam SF. Laparoscopic transperitoneal repair of pediatric diaphragm eventration using an endostapler device. J Laparoendosc Adv Surg Tech A. 2013;23:808–13.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Thomas RJ, Kishore R, Kisku S. A helping clamp for thoracoscopic plication of eventration of the diaphragm. J Indian Assoc Pediatr Surg. 2011;16:97–8.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Takahashi T, Okazaki T, Ochi T, et al. Thoracoscopic plication for diaphragmatic eventration in a neonate. Ann Thorac Cardiovasc Surg. 2013;19:243–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Shimizu M. Bilateral phrenic-nerve paralysis treated by thoracoscopic diaphragmatic plication in a neonate. Pediatr Surg Int. 2003;19:79–81.PubMedGoogle Scholar
  43. 43.
    Baker CJ, Boulom V, Reemtsen BL, et al. Hemidiaphragm plication after repair of congenital heart defects in children: quantitative return of diaphragm function over time. J Thorac Cardiovasc Surg. 2008;135:56–61.CrossRefPubMedGoogle Scholar
  44. 44.
    van Onna IE, Metz R, Jekel L, et al. Post cardiac surgery phrenic nerve palsy: value of plication and potential for recovery. Eur J Cardiothorac Surg. 1998;14:179–84.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Jun Fujishiro
    • 1
    Email author
  • Tetsuya Ishimaru
    • 1
  • Masahiko Sugiyama
    • 1
  • Mari Arai
    • 1
  • Keisuke Suzuki
    • 2
  • Hiroshi Kawashima
    • 2
  • Tadashi Iwanaka
    • 1
    • 3
  1. 1.Department of Pediatric Surgery, Faculty of MedicineThe University of TokyoTokyoJapan
  2. 2.Division of SurgerySaitama Children’s Medical CenterSaitamaJapan
  3. 3.Saitama Children’s Medical CenterSaitamaJapan

Personalised recommendations