A simple thoracoscopic plication technique for diaphragmatic eventration in neonates and infants: technical details and initial results.

Abstract

Existing minimal-access surgical approaches for correction of symptomatic diaphragmatic eventration may be technically difficult in neonates and infants. We report technical details and initial outcomes of a novel, simple thoracoscopic repair technique. The technique uses one 3-mm camera port, a 3-mm instrument incision without a port, and an 18-gauge spinal needle, which is passed through the chest wall into the pleural space. The excess diaphragm is first plicated over the needle, after which a non-absorbable suture is passed through the needle and tied extracorporeally. The needle is passed repeatedly until the desired degree of tension is achieved. A retrospective review was performed for all patients undergoing repair by this technique. Nine patients have undergone thoracoscopic plication at a median age of 3months (range 0.2-13.2 mos.) and a median weight of 4.5kg (range 2.3-8.2kg). No organ injuries or conversions to thoracotomy occurred. Median operative time was 60min. Patients repaired beyond the neonatal period were extubated in the operating room. There were two post-operative pneumothoraces. No recurrences have been seen at a mean follow-up of 17months. This technique of thoracoscopic diaphragm plication is safe, effective, and technically straightforward in neonates and infants.