Skip to main content
SpringerLink
Log in

Thoracoscopic repair of congenital diaphragmatic hernia: a new anatomical reconstructive concept for tension dispersal at primary closure

Surgical Endoscopy volume 35, pages 3279–3284 (2021)Cite this article

A Correction to this article was published on 14 July 2020

This article has been updated

Abstract

Background

Several measures were implemented among authors striving to tail off recurrence rates of thoracoscopic congenital diaphragmatic hernia repair. In the presented study, we extended the use of rib-anchoring stitches to reorient the diaphragmatic muscle leaflets in the types B&C diaphragmatic hernias, to achieve tension dispersal at primary thoracoscopic repair.

Patients and methods

Included in this study were early and late-onset lateral congenital diaphragmatic hernia patients, who had been operated upon in the years 2012 through 2018. A preliminary stitch was taken between posterior muscle edge and rib cage to reorient the diaphragmatic defect into a reversed C-shaped line. The lateral portion was closed by additional rib-anchoring stitches, while the medial one necessitated muscle to muscle stitches. Primary outcome being validated was the recurrence rate within a year post repair.

Results

In the 7-year inclusion period, 36 congenital diaphragmatic hernia cases were managed using the described approach. The repair was accomplished thoracoscopically in all but two cases, who were excluded from the study. Mean operative time was 76 min. No pledgets or synthetic patches were applied. Mean length of hospital stay was 7.6 days. Early postoperative course was uneventful in all but four cases; two ventilatory barotrauma and two mortalities. After a mean follow-up period of 29 months, five recurrences were reported (16%). Ipsilateral chest wall deformity was noticed in one case 3 years post repair.

Conclusion

In the presented study, authors adopted thoracoscopic reorientation of diaphragmatic muscle leaflets in lateral congenital diaphragmatic hernia cases to achieve tension dispersal at primary repair. Short and mid-term results supported the efficacy and reproducibility of the described approach. However, long-term comparative studies seemed a necessity to validate this outcome.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Change history

Notes

  1. Ibis; a sacred Egyptian bird with a peculiar sickle-shaped peak and head.

References

  1. Keijzer R, Puri P (2010) Congenital diaphragmatic hernia. Semin Pediatr Surg 19:180–185

    Article  Google Scholar 

  2. Clugston RD, Greer JJ (2007) Diaphragm development and congenital diaphragmatic hernia. Semin Pediatr Surg 16:94–100

    Article  Google Scholar 

  3. Lally KP, Lasky RE, Lally PA et al (2013) Standardized reporting for congenital diaphragmatic hernia—an international consensus. J Pediatr Surg 48:2408–2415

    Article  Google Scholar 

  4. Silen ML, Canvasser DA, Kurkchubasche AG et al (1995) Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia. Ann Thorac Surg 60:448–450

    Article  CAS  Google Scholar 

  5. Lansdale N, Alam S, Losty PD et al (2010) Neonatal endosurgical congenital diaphragmatic hernia repair: a systematic review and meta-analysis. Ann Surg 252:20–26

    Article  Google Scholar 

  6. Szavay PO, Obermayr F, Maas C et al (2012) Perioperative outcome of patients with congenital diaphragmatic hernia undergoing open versus minimally invasive surgery. J Laparoendosc Adv Surg Tech 22:285–289

    Article  Google Scholar 

  7. Keijzer R, van de Ven C, Vlot J et al (2010) Thoracoscopic repair in congenital diaphragmatic hernia: patching is safe and reduces the recurrence rate. J Pediatr Surg 45:953–957

    Article  Google Scholar 

  8. Gander JW, Fisher JC, Gross ER et al (2011) Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study. J Pediatr Surg 46:1303–1308

    Article  Google Scholar 

  9. Lacher M, St Peter SD, Laje P et al (2015) Thoracoscopic CDH repair—a survey on opinion and experience among IPEG members. J Laparoendosc Adv Surg Tech 25(11):954–957

    Article  Google Scholar 

  10. Arca MJ, Barnhart DC, Lelli JL Jr et al (2003) Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg 38:1563–1568

    Article  Google Scholar 

  11. Cho SD, Krishnaswami S, Mckee JC et al (2009) Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls. J Pediatr Surg 44:80–86

    Article  Google Scholar 

  12. Okazaki T, Nishimura K, Takahashi T et al (2011) Indications for thoracoscopic repair of congenital diaphragmatic hernia in neonates. Pediatr Surg Int 27:35–38

    Article  Google Scholar 

  13. Becmeur F, Reinberg O, Dimitriu C et al (2007) Thoracoscopic repair of congenital diaphragmatic hernia in children. Semin Pediatr Surg 16:238–244

    Article  Google Scholar 

  14. McHoney M, Giacomello L, Nah SA et al (2010) Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence. J Pediatr Surg 45:355–359

    Article  Google Scholar 

  15. Jancelewicz T, Langer JC, Chiang M et al (2013) Thoracoscopic repair of neonatal congenital diaphragmatic hernia (CDH): outcomes after a systematic quality improvement process. J Pediatr Surg 48:321–325

    Article  Google Scholar 

  16. Gourlay DM, Cassidy LD, Sato TT et al (2009) Beyond feasibility: a comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias. J Pediatr Surg 44:1702–1707

    Article  Google Scholar 

  17. Shah SR, Wishnew J, Barsness K et al (2009) Minimally invasive congenital diaphragmatic hernia repair: a 7-year review of one institution’s experience. Surg Endosc 23:1265–1271

    Article  Google Scholar 

  18. Yang EY, Allmendinger N, Johnson SM et al (2005) (2005) Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome. J Pediatr Surg 40:1369–1375

    Article  Google Scholar 

  19. Nguyen TL, Le AD (2006) Thoracoscopic repair for congenital diaphragmatic hernia: lessons from 45 cases. J Pediatr Surg 41:1713–1715

    Article  Google Scholar 

  20. Al-Jazaeri A (2012) Simplified technique for minimally invasive repair of congenital diaphragmatic hernia using hollow-needle snare and transthoracic traction stitches. J Pediatr Surg 47:258–263

    Article  Google Scholar 

  21. Ellinas H, Seefelder C (2010) Congenital diaphragmatic hernia repair in neonates: is thoracoscopy feasible? Paediatr Anaesth 20:967–969

    Article  Google Scholar 

  22. Gomes Ferreira C, Reinberg O, Becmeur F et al (2009) Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy. Surg Endosc 23:1650–1659

    Article  Google Scholar 

  23. Gupta RK, Parelkar SV, Oak SN et al (2011) Early experience with thoracoscopic repair of congenital diaphragmatic hernias in pediatric age group: results and lessons learned. Pediatr Surg Int 27:563–566

    Article  Google Scholar 

  24. Said SM, Moir CR, Ishitani MB et al (2010) Successful thoracoscopic staged repair of bilateral congenital diaphragmatic hernia. J Pediatr Surg 45:E5–E8

    Article  Google Scholar 

  25. Nam SH, Cho MJ, Kim DY et al (2013) Shifting from laparotomy to thoracoscopic repair of congenital diaphragmatic hernia in neonates: early experience. World J Surg 37:2711–2716

    Article  Google Scholar 

  26. Ferreira CG, Kuhn P, Lacreuse I et al (2013) Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates. J Pediatr Surg 48:488–495

    Article  Google Scholar 

  27. Fishman JR, Blackburn SC, Jones NJ et al (2011) Does thoracoscopic congenital diaphragmatic hernia repair cause a significant intraoperative acidosis when compared to an open abdominal approach? J Pediatr Surg 46:458–461

    Article  Google Scholar 

  28. Inoue M, Uchida K, Otake K et al (2016) Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy. Surg Endosc. https://doi.org/10.1007/s00464-015-4287-6

    Article  PubMed  Google Scholar 

  29. Reiss I, Schaible T, van den Hout L et al (2010) Standardized postnatal management of infants with congenital Diaphragmatic hernia in Europe: the CDH EURO Consortium Consensus. Neonatology 98:354–364

    Article  CAS  Google Scholar 

  30. Kim AC, Bryner BS, Akay B et al (2009) Thoracoscopic repair of congenital diaphragmatic hernia in neonates: lessons learned. J Laparoendosc Adv Surg Tech 19(4):575–580

    Article  Google Scholar 

  31. Guner YS, Chokshi N, Aranda A et al (2008) Thoracoscopic repair of neonatal diaphragmatic hernia. J Laparoendosc Adv Surg Tech A 18:875–880

    Article  Google Scholar 

  32. Yang EY, Allmendinger N, Johnson SM et al (2005) Neonatal thoracoscopic repair of congenital diaphragmatic hernia: Selection criteria for successful out- come. J Pediatr Surg 40:1369–1375

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Surgery Department/Section - Minimally Invasive Surgery Unit, Cairo University Specialised Pediatric Hospital (CUSPH), Faculty of Medicine (Kasr Alainy), Cairo University, Cairo, Egypt

    Mohamed M. Elbarbary & Mahmoud M. Marei

  2. Fayoum University, El Fayoum, Egypt

    Ahmed E. Fares

  3. Tanta University Hospital, Tanta, Egypt

    Hamed M. Seleim

Authors
  1. Mohamed M. Elbarbary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed E. Fares
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahmoud M. Marei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hamed M. Seleim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hamed M. Seleim.

Ethics declarations

Disclosures

Mohamed M. Elbarbary, Ahmed E. Fares, Mahmoud M. Marei, and Hamed M. Seleim have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article was updated to correct the spelling of Mohamed M. Elbarbary’s last name and to correct Affiliations 1 and 2.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (MOV 91753 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elbarbary, M.M., Fares, A.E., Marei, M.M. et al. Thoracoscopic repair of congenital diaphragmatic hernia: a new anatomical reconstructive concept for tension dispersal at primary closure. Surg Endosc 35, 3279–3284 (2021). https://doi.org/10.1007/s00464-020-07764-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07764-5

Keywords

search

Navigation