Thoracoscopic Repair of Congenital Diaphragmatic Hernia: a Tale from Two Cities

Abstract

The prolific advances of minimal invasive surgery (MIS) have made many of the complex pediatric surgical problems amenable to these procedures for more benefits. Nowadays, successful repair of congenital diaphragmatic hernia (CDH) by thoracoscopic and laparoscopic techniques is no exception. Our study aims to highlight the surgical technique, initial results, and overview the indications of thoracoscopic repair of congenital diaphragmatic hernia (CDH). A prospective study was conducted from April 2016 to March 2018 in 2 tertiary centers in Egypt. All confirmed CDH patients were assessed for the possibility of thoracoscopic repair. Oxygenation index (OI) was used to assess the severity of persistent pulmonary hypertension (PPH). It is calculated by the following equation: MAP × FiO2 × 100 ÷ PaO2. Babies having OI < 5 are considered to have mild pulmonary hypertension; thus, thoracoscopic repair was offered for them. Thirty four CDH cases met the selection criteria; therefore, they underwent thoracoscopic repair. Group 1 included 14 late-presenting CDH patients, while 20 neonatal presenting CDH were included in group 2. Conversion to open repair occurred in 5 cases, with causes related to surgical factors, and none was due to pure anesthetic problem or general deterioration during thoracoscopy. Recurrence was discovered in 1 case only. Thoracoscopic repair of CDH is safe and feasible in treatment of late-presenting CDH. However, in neonatal CDH should the patients are assessed strictly; safety and feasibility are retained, and the conversion to open surgery is minimized.