Pitfalls and Solutions in Endoscopic Surgery for Late-Presenting Congenital Diaphragmatic Hernia

Abstract

In this paper, we review the clinical courses and recorded operative videos of our six patients who underwent endoscopic surgery for late-presenting congenital diaphragmatic hernia (Late-CDH) and discuss the pitfalls and solutions for surgery completion. The two patients who underwent laparoscopic surgery had problems with instability of the operation field during the suturing procedure, especially in external ligation. One of these patients was subsequently switched to laparotomy, and the other had postoperative transient hyperamylasemia, probably due to compression maneuvers of the spleen and pancreatic body. In laparoscopic surgery, mild fluctuation of the pneumoperitoneum pressure may push the repositioned organ into the diaphragmatic defect; thus, a reliable and stable method of organ compression must be considered. In one thoracoscopically treated patient, it was difficult to reduce the enlarged colon into the abdomen. If the prolapsed colon is dilated during thoracoscopic surgery, it is important to first reduce the small intestine and then the colon, stomach, and finally the spleen. In endoscopic surgery for Late-CDH, it is important to secure the operation field, and measures must be taken against obstruction by the prolapsed bowel and organs.