A novel technique: self-made hernia silk ring pins with two ports for thoracoscopic repairing of congenital diaphragmatic hernia in neonates

Abstract

Objective To explore the proper surgical indications and safety of thoracoscopic repairing with self-made hernia ring pins in neonates with congenital diaphragmatic hernia (CDH). Methods Twenty CDH cases undergoing thoracoscopic repair were recruited during January 2016 to May 2018. They were divided into two groups of traditional thoracoscopic repair (TTR) and thoracoscopic repair with self-made hernia ring pins (TRHP). Clinical data of birth weight, gestational week, operative age, length of postoperative stay and number of recurrent cases were compared between two groups. The size of defect was coded into grades A, B, C and D by the Congenital Diaphragmatic Hernia Study Group. They were divided into stages Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ according to defect size and complicated congenital heart disease. Results There were 3 boys and 3 girls in TRHP group. Three cases each belonged to A and B-class defects respectively. The contents of hernia included small intestine, colon, kidney and spleen. Five cases presented with left CDH and one right CDH. One of left CDH cases and another one case of right CDH had hernia sac. Right CDH neonate had an onset of hematuria at Day 1 and Day 2 post-operation. Their symptoms disappeared after treatment. No recurrent case was found. All cases in TRHP group belonged to Ⅰ/Ⅱ stage. There were 14 cases in TTR group. Numbers of cases belonging to A, B and C-class defect were 7, 5 and 2 respectively. Cases of A and B defects were in stageⅠ/Ⅱ and cases of C defect in stage Ⅲ. Among 12 cases of A/B defect, there were left CDH (n=10) and right CDH (n=2). Three cases had hernia sac. The contents of hernia included small intestine, colon, kidney and spleen. No complications were found in either group. No significant differences existed in area of birth weight, gestational week or operative age (P>0.05) while significant difference existed in operative time [(49.0±10.75) min vs. (80.17±6.86) min, P<0.05]. No recurrent cases were found during follow-ups. Conclusions Thoracoscopic repairing with self-made hernia ring pins is both safe and feasible for CDH neonates with grade B, TTR or open repair is advised. Key words: Thoracoscopes; Neonate; Diaphragmatic hernia; Hernia pins