Thoracoscopic repair for congenital diaphragmatic hernia
Key words: Diaphragmatic hernia, Congenital, Thoracoscopic
Aim of study:
To analyze indications and to present details of surgical technique and outcomes of thoracoscopic repair for congenital diaphragmatic hernia (CDH) in 25 patients.
We reviewed medical records of all 25 patients with CDH who underwent thoracoscopic repair by the same surgical team from October 2013 to October 2017. After patients were placed in the lateral decubitus position the operations were performed using three trocars one 5mm for camera & two 3mm working ports. Pleural insufflation with carbon dioxide was maintained at a pressure of 4–6 mm Hg. The hernia defect was repaired using nonabsorable interrupted intracorporeal knots. A prosthetic patch was used when direct closure was not feasible.
There were 25 patients, including 12 boys and 13 girls. 8 patients patients were newborns and 17 were infants or children. The hernia was located on the left side in 20 patients and on right side in 5 patients. The operative time for thoracoscopic approach was between 80 to 120 minutes. Conversion was required in one patient who was not maintaining saturation. A prosthetic patch was used in 2 patients who are having wide lateral defect and deficient muscle. There were 1 postoperative deaths & Follow-up was obtained in 22 patients ranging from 1 to 6 months. 1 patient had recurrence .
Thoracoscopic repair is feasible and safe for neonates & infants with CDH. The conversion rate can be there in initially learning curve. Our initial results are better because majority of patients were not neonates presented bit later in infancy & in stable condition
PROF. ALI RAZA BROHI
MBBS, FCPS, FEBPS, FACS, Dip.MAS
Professor of paediatric surgery
Peoples University of medical & health sciences Nawabshah, Pakistan