Simple and safe thoracoscopic repair of neonatal congenital diaphragmatic hernia by a new modified knot-tying technique
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Clinical outcomes in infants with congenital diaphragmatic hernia (CDH) may be improved by thoracoscopic repair. However, the limited domain and large diaphragmatic defects in neonates are obstacles. Here, we present a special knot-tying technique that facilitates a safe and efficient thoracoscopic CDH repair in neonates.
An extracorporeal slip knot is assembled after a stitch through the diaphragmatic edge, one end of the string is pulled, and the knot slides to reach the diaphragm easily without a knot-pusher. Then two more uncomplicated single-loop knots are performed to secure its tightness intrathoracically. Twenty-six consecutive neonates with CDH were treated by this technique. The technical advantages and clinical outcomes were evaluated.
All 26 patients were treated successfully, including 6 patch-repairs and 1 case with associated extra-lobar pulmonary sequestration. The mean operative times with and without patch-repair were 149 ± 26 min and 95 ± 25 min, respectively. All cases were completed without conversion. No recurrence was observed at a median follow-up of 13.7 months (range 5.8–29.8 months).
This special knot-tying technique is easy to learn and does not require any additional devices. It is a simple and accessible technique that can facilitate thoracoscopic repair of neonatal CDH within the limited space and with patch-repair.
KeywordsCongenital diaphragmatic hernia Neonate Thoracoscopy Knot-tying technique
We thank Dr. Sundeep G. Keswani and Dr. Timothy C. Lee (Texas Children’s Hospital, Houston, Texas, USA) for their critical review of the manuscript.
Compliance with ethical standards
Conflict of interest
All authors declare no conflict of interest.
No ethical approval was required for this study.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
As all cases are anonymised, informed consent was not required.
Supplementary file1 (AVI 81291 kb)
- 9.Riquelme MA, Guajardo CD, Juarez-Parra MA et al (2015) Thoracoscopic Patch Repair of Congenital Diaphragmatic Hernia in a Neonate using Spiral Tacks: A Case Report. Journal of neonatal surgery 4:31Google Scholar
- 12.Lishuang M, Yandong W, Shuli L et al (2017) A comparison of clinical outcomes between endoscopic and open surgery to repair neonatal diaphragmatic hernia. J Minimal Access Surg 13:182–187Google Scholar