2020 Volume 56 Issue 6 Pages 926-931
Purpose: Late-presenting congenital diaphragmatic hernia is a good indication for endoscopic surgery. However, congenital diaphragmatic hernia with a large diaphragmatic defect does not commonly indicate endoscopic repair because of the high recurrence rate. In this study, we aimed to elucidate the relationship between defect size and the surgical procedure performed in patients with late-presenting congenital diaphragmatic hernia repaired by endoscopic surgery.
Methods: We reviewed the medical records of patients with late-presenting congenital diaphragmatic hernia treated in our hospital between October 2015 and September 2019. The underlying diseases, preoperative care, surgical procedures, and operative outcomes were retrospectively reviewed.
Results: Seven patients (five men and two women) were included in this study. The underlying diseases were contralateral neonatal congenital diaphragmatic hernia in one patient, trisomy 21 in one, and tetralogy of Fallot in one. Two patients underwent laparoscopic surgery, and five, thoracoscopic surgery. Defect size was categorized using the Congenital Diaphragmatic Hernia Study Group classification. Two patients had an “A defect,” and five had a “B defect.” All patients underwent diaphragmatic repair without a patch. Two patients with large B defects underwent surgery combined with a direct suture and hernia sac plication. All patients underwent endoscopic surgery without any complications or recurrence.
Conclusions: This report demonstrates that late-presenting congenital diaphragmatic hernia could be repaired by endoscopic primary closure of the diaphragm without a patch. When the diaphragm is difficult to repair with direct closure, a combination of direct suture and hernia sac plication can be used instead.
