We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
A Multi-Institutional Review of Thoracoscopic Congenital Diaphragmatic Hernia Repair.
- Authors
Weaver, Katrina L.; Baerg, Joanne E.; Okawada, Manabu; Miyano, Go; Barsness, Katherine A.; Lacher, Martin; Gonzalez, Dani O.; Minneci, Peter C.; Perger, Lena; St. Peter, Shawn D.
- Abstract
<bold>Introduction: </bold>Thoracoscopic repair of a congenital diaphragmatic hernia (CDH) in the neonate is controversial due to reports of increased hernia recurrence. A multicenter review on thoracoscopic CDH repair was conducted to evaluate outcomes and to identify factors that are associated with recurrence.<bold>Methods: </bold>A multicenter retrospective review was conducted from 2009 to 2015 in neonates who were treated for CDH with thoracoscopic repair. Demographics, preoperative, intraoperative, including repair techniques, and postoperative variables were analyzed by using descriptive statistics. Comparative analysis was performed between those patients who were repaired entirely thoracoscopically with hernia recurrence and those without.<bold>Results: </bold>One hundred nine infants, of whom 57% were male with an average gestational age at time of surgery of 39.6 ± 4.6 weeks and a weight of 3.4 ± 1.1 kg, were included. The median age at repair was 5 days (range: 3-9), 61% patients required vasopressor support, and 1.8% patients required extracorporeal membrane oxygenation (ECMO) cannulation before repair. Forty-five percent were repaired on high-frequency oscillatory ventilation (HFOV). Repair was completed thoracoscopically in 83 patients (76%), 68 (82%) were repaired primarily, 15 (18%) were repaired with a patch, and 50 (60%) had extracorporeal/rib fixation sutures. Recurrence occurred in 7 (8.4%) of those completed thoracoscopically. Factors found to be significant for recurrence included: vasopressor therapy (P = .02), repair on HFOV (P = .04), and the presence of the spleen in the chest (P = .04). There was no significant difference identified between technical variations in repair.<bold>Conclusions: </bold>These data suggest that thoracoscopic repair of CDH is feasible in carefully selected patients. However, there is currently no evidence to support a standardized surgical approach to thoracoscopic repair.
- Subjects
CHEST endoscopic surgery; DIAPHRAGMATIC hernia; NEONATAL diseases; DISEASE relapse; SURGERY; THERAPEUTICS; VASOCONSTRICTORS; BIRTH weight; COMPARATIVE studies; EXTRACORPOREAL membrane oxygenation; GENETIC disorders; GESTATIONAL age; HERNIA surgery; HIGH-frequency ventilation (Therapy); RESEARCH methodology; MEDICAL cooperation; RESEARCH; THORACOSCOPY; EVALUATION research; TREATMENT effectiveness; RETROSPECTIVE studies
- Publication
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2016, Vol 26, Issue 10, p825
- ISSN
1092-6429
- Publication type
journal article
- DOI
10.1089/lap.2016.0358