, Volume 23, Issue 6, pp 1275–1278 | Cite as

Simple and safe thoracoscopic repair of neonatal congenital diaphragmatic hernia by a new modified knot-tying technique

  • Q. He
  • W. ZhongEmail author
  • Z. Wang
  • B. Yan
  • X. Xie
  • J. Yu



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.


Congenital 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.

Ethical approval

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.

Informed consent

As all cases are anonymised, informed consent was not required.

Supplementary material

Supplementary file1 (AVI 81291 kb)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Q. He
    • 1
  • W. Zhong
    • 1
    Email author
  • Z. Wang
    • 1
  • B. Yan
    • 1
  • X. Xie
    • 1
  • J. Yu
    • 1
  1. 1.Department of Neonatal Surgery, Guangzhou Women and Children’s Medical CenterGuangzhou Medical UniversityGuangzhouChina

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