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Tension-free thoracoscopic repair of congenital diaphragmatic hernia combined with a percutaneous extracorporeal closure technique: how to do it

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Abstract

Purpose

Thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) is associated with a higher recurrence rate than the conventional open method. We evaluated the effectiveness of our strategy for quality improvement, named “tension-free TR of CDH”.

Methods

The subjects of this retrospective analysis were 11 consecutive patients with CDH who underwent TR at our hospital between 2017 and 2021. Tension-free TR of CDH included the proactive use of an oversized patch for dome-shaped reconstruction and gapless suturing. We developed a percutaneous extracorporeal closure technique for secure suturing using a commercially available needle.

Results

Patch repair was performed in 8 (73%) patients and none required conversion to open surgery because of technical difficulties. Recurrence developed in one patient (9%), who underwent successful reoperation via TR. All patients had an uneventful postoperative course.

Conclusion

Tension-free TR combined with extracorporeal closure could reduce the difficulty of suturing and the risk of recurrence of CDH.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-Shi, Osaka, Japan

    Koichi Deguchi, Miho Watanabe, Tomohisa Yoneyama, Kazunori Masahata, Motonari Nomura, Ryuta Saka, Hiroaki Yamanaka, Masafumi Kamiyama, Takehisa Ueno, Yuko Tazuke & Hiroomi Okuyama

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  1. Koichi Deguchi
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  2. Miho Watanabe
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  3. Tomohisa Yoneyama
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  4. Kazunori Masahata
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  5. Motonari Nomura
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  6. Ryuta Saka
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  7. Hiroaki Yamanaka
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  8. Masafumi Kamiyama
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  9. Takehisa Ueno
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  10. Yuko Tazuke
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  11. Hiroomi Okuyama
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Contributions

The authors confirm contributions to the paper as follows: study conception and design: KD, MW and HO; data collection: YT and KD; analysis and interpretation of results: KD, MW, TY, KM, MN, RS, HY, MK, TU and YT; draft manuscript preparation: KD, MW and HO. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Hiroomi Okuyama.

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Intraoperative movie showing the percutaneous extracorporeal closure technique using Lapa-her-closure® (MP4 79729 KB)

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Deguchi, K., Watanabe, M., Yoneyama, T. et al. Tension-free thoracoscopic repair of congenital diaphragmatic hernia combined with a percutaneous extracorporeal closure technique: how to do it. Surg Today 53, 640–646 (2023). https://doi.org/10.1007/s00595-022-02609-1

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  • DOI: https://doi.org/10.1007/s00595-022-02609-1

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