Thoracoscopic repair of neonatal congenital diaphragmatic hernia

Abstract

Purpose: To describe the surgical technique and criteria for neonatal congenital diaphragmatic hernia (CDH) repair. Methods: CDH repairs were carried out by a thoracoscopic approach between February 2013 and April 2014. Preoperatively, the neonates were stabilized with high-frequency oscillatory ventilation and nitric oxide inhalation. They had no associated cardiac anomalies. Confirmation of the appropriateness of thoracoscopic repair was determined based on the patient’s stability in the decubitus position and no clinical signs of pulmonary hypertension. The operation was carried out with one optical and two operating trocars. The hernia defect was closed by interrupted nonabsorbable sutures. The more lateral portion of the defect was repaired with a U-shaped stitch using a laparoscopic percutaneous extraperitoneal closure needle. Results: Three neonates underwent repair via thoracoscopy. Two patients underwent primary CDH repair, and conversion to laparotomy was required in the other because of a large diaphragmatic defect. There was no intraoperative cardiorespiratory instability or postoperative complications. Conclusions: Thoracoscopic repair of neonatal CDH is a feasible and safe procedure for the patients who have respiratory stability in the decubitus position, no pulmonary hypertension and no intra-thoracic liver herniation.