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.
Similar content being viewed by others
References
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.
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.
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.
van der Zee DC, Bax NM. Laparoscopic repair of congenital diaphragmatic hernia in a 6-month-old child. Surg Endosc. 1995;9:1001–3.
Shah AV, Shah AA. Laparoscopic approach to surgical management of congenital diaphragmatic hernia in the newborn. J Pediatr Surg. 2002;37:548–50.
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.
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.
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.
Tsao K, Lally PA, Lally KP. Minimally invasive repair of congenital diaphragmatic hernia. J Pediatr Surg. 2011;46:1158–64.
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.
Becmeur F, Reinberg O, Dimitriu C, et al. Thoracoscopic repair of congenital diaphragmatic hernia in children. Semin Pediatr Surg. 2007;16:238–44.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Dingemann C, Ure B, Dingemann J. Thoracoscopic procedures in pediatric surgery: what is the evidence? Eur J Pediatr Surg. 2014;24:14–9.
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.
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.
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.
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).
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).
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).
Bielinska M, Jay PY, Erlich JM, et al. Molecular genetics of congenital diaphragmatic defects. Ann Med. 2007;39:261–74.
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.
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.
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.
Hines MH. Video-assisted diaphragm plication in children. Ann Thorac Surg. 2003;76:234–6.
Tanaka Y, Iwanaka T. Thoracoscopic diaphragmatic plication in small infants. Asian J Endosc Surg. 2011;3:169–73.
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.
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.
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.
Takahashi T, Okazaki T, Ochi T, et al. Thoracoscopic plication for diaphragmatic eventration in a neonate. Ann Thorac Cardiovasc Surg. 2013;19:243–6.
Shimizu M. Bilateral phrenic-nerve paralysis treated by thoracoscopic diaphragmatic plication in a neonate. Pediatr Surg Int. 2003;19:79–81.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fujishiro, J., Ishimaru, T., Sugiyama, M. et al. Minimally invasive surgery for diaphragmatic diseases in neonates and infants. Surg Today 46, 757–763 (2016). https://doi.org/10.1007/s00595-015-1222-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-015-1222-3