Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls

S. David Cho, Sanjay Krishnaswami, Julie C. Mckee, Garret Zallen, Mark L. Silen, David W. Bliss

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Purpose: The applicability of minimally invasive surgical techniques to pediatric surgical diseases continues to grow. Surgeons have hesitated to apply these methods to congenital diaphragmatic hernia (CDH) of Bochdalek because of the disease-associated pulmonary hypertension and patient fragility. We began performing thoracoscopic repair (CDH-T) in 2004 and have since completed 29 sequential repairs. To evaluate feasibility and outcomes, we compared this experience to a historical control group who underwent open repair (CDH-O) at the same institution by the same surgeons from 2001 to 2004. Methods: From January 2001 through November 2007, 72 neonates were evaluated jointly by the Neonatology and Pediatric Surgical services for CDH. Fifteen infants died before any corrective operation and were excluded from analysis. Demographics including gestational age, birth weight, Apgar scores, percent outborn, usage of extracorporeal life support, and associated anomalies were recorded. End points were complications, additional operative procedures, initial patch closure, recurrence, length of stay in non-extracorporeal membrane oxygenation patients, and postoperative mortality. Results: Demographic characteristics were similar between the 2 groups. There were no statistically significant differences in complications (71.5% vs 55%, P = .28), additional related operative procedures (42.9% vs 34.5%, P = .59), use of prosthetic patch (42.8% vs 51.7%, P = .60), recurrence (6.9% vs 20.7%, P = .25), length of stay (24 vs 34 days, P = .11), or postoperative mortality (21.4% vs 6.9%, P = .14) between the CDH-O and CDH-T groups, respectively. There was one conversion in the CDH-T group (3.4%). Conclusions: To our knowledge, this is the largest reported series of CDH-T of neonatal CDH of Bochdalek. We have demonstrated the feasibility of performing this procedure thoracoscopically in an unselected population including children who have undergone prior extracorporeal life support. These results compare favorably with CDH-O, although further follow-up is required to determine the durability of the approach.

Original languageEnglish (US)
Pages (from-to)80-86
Number of pages7
JournalJournal of Pediatric Surgery
Volume44
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Newborn Infant
Extracorporeal Membrane Oxygenation
Operative Surgical Procedures
Length of Stay
Demography
Congenital Diaphragmatic Hernias
Pediatrics
Neonatology
Recurrence
Apgar Score
Mortality
Pulmonary Hypertension
Birth Weight
Gestational Age
Control Groups
Membranes
Population

Keywords

  • Diaphragmatic hernia
  • Minimally invasive surgery
  • Neonatal
  • Pediatric surgery
  • Thoracoscopic

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls. / Cho, S. David; Krishnaswami, Sanjay; Mckee, Julie C.; Zallen, Garret; Silen, Mark L.; Bliss, David W.

In: Journal of Pediatric Surgery, Vol. 44, No. 1, 01.2009, p. 80-86.

Research output: Contribution to journalArticle

Cho, S. David ; Krishnaswami, Sanjay ; Mckee, Julie C. ; Zallen, Garret ; Silen, Mark L. ; Bliss, David W. / Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls. In: Journal of Pediatric Surgery. 2009 ; Vol. 44, No. 1. pp. 80-86.
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abstract = "Purpose: The applicability of minimally invasive surgical techniques to pediatric surgical diseases continues to grow. Surgeons have hesitated to apply these methods to congenital diaphragmatic hernia (CDH) of Bochdalek because of the disease-associated pulmonary hypertension and patient fragility. We began performing thoracoscopic repair (CDH-T) in 2004 and have since completed 29 sequential repairs. To evaluate feasibility and outcomes, we compared this experience to a historical control group who underwent open repair (CDH-O) at the same institution by the same surgeons from 2001 to 2004. Methods: From January 2001 through November 2007, 72 neonates were evaluated jointly by the Neonatology and Pediatric Surgical services for CDH. Fifteen infants died before any corrective operation and were excluded from analysis. Demographics including gestational age, birth weight, Apgar scores, percent outborn, usage of extracorporeal life support, and associated anomalies were recorded. End points were complications, additional operative procedures, initial patch closure, recurrence, length of stay in non-extracorporeal membrane oxygenation patients, and postoperative mortality. Results: Demographic characteristics were similar between the 2 groups. There were no statistically significant differences in complications (71.5{\%} vs 55{\%}, P = .28), additional related operative procedures (42.9{\%} vs 34.5{\%}, P = .59), use of prosthetic patch (42.8{\%} vs 51.7{\%}, P = .60), recurrence (6.9{\%} vs 20.7{\%}, P = .25), length of stay (24 vs 34 days, P = .11), or postoperative mortality (21.4{\%} vs 6.9{\%}, P = .14) between the CDH-O and CDH-T groups, respectively. There was one conversion in the CDH-T group (3.4{\%}). Conclusions: To our knowledge, this is the largest reported series of CDH-T of neonatal CDH of Bochdalek. We have demonstrated the feasibility of performing this procedure thoracoscopically in an unselected population including children who have undergone prior extracorporeal life support. These results compare favorably with CDH-O, although further follow-up is required to determine the durability of the approach.",
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AU - Bliss, David W.

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N2 - Purpose: The applicability of minimally invasive surgical techniques to pediatric surgical diseases continues to grow. Surgeons have hesitated to apply these methods to congenital diaphragmatic hernia (CDH) of Bochdalek because of the disease-associated pulmonary hypertension and patient fragility. We began performing thoracoscopic repair (CDH-T) in 2004 and have since completed 29 sequential repairs. To evaluate feasibility and outcomes, we compared this experience to a historical control group who underwent open repair (CDH-O) at the same institution by the same surgeons from 2001 to 2004. Methods: From January 2001 through November 2007, 72 neonates were evaluated jointly by the Neonatology and Pediatric Surgical services for CDH. Fifteen infants died before any corrective operation and were excluded from analysis. Demographics including gestational age, birth weight, Apgar scores, percent outborn, usage of extracorporeal life support, and associated anomalies were recorded. End points were complications, additional operative procedures, initial patch closure, recurrence, length of stay in non-extracorporeal membrane oxygenation patients, and postoperative mortality. Results: Demographic characteristics were similar between the 2 groups. There were no statistically significant differences in complications (71.5% vs 55%, P = .28), additional related operative procedures (42.9% vs 34.5%, P = .59), use of prosthetic patch (42.8% vs 51.7%, P = .60), recurrence (6.9% vs 20.7%, P = .25), length of stay (24 vs 34 days, P = .11), or postoperative mortality (21.4% vs 6.9%, P = .14) between the CDH-O and CDH-T groups, respectively. There was one conversion in the CDH-T group (3.4%). Conclusions: To our knowledge, this is the largest reported series of CDH-T of neonatal CDH of Bochdalek. We have demonstrated the feasibility of performing this procedure thoracoscopically in an unselected population including children who have undergone prior extracorporeal life support. These results compare favorably with CDH-O, although further follow-up is required to determine the durability of the approach.

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