Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study

Abstract

Introduction Experience in thoracoscopic congenital diaphragmatic hernia (CDH) repair has expanded, yet efficacy equal to that of open repair has not been demonstrated. In spite of reports suggesting higher recurrent hernia rates after thoracoscopic repair, this approach has widely been adopted into practice. We report a large, single institutional experience with thoracoscopic CDH repair with special attention to recurrent hernia rates. Methods We reviewed the records of neonates with unilateral CDH repaired between January 2006 and February 2010 at Morgan Stanley Children’s Hospital. Completely thoracoscopic repairs were compared to open repairs of the same period. In addition, successful thoracoscopic repairs were compared with thoracoscopic repairs that developed recurrence. Data were analyzed by Mann-Whitney U and Fisher exact tests. Results Thirty-five neonates underwent attempted thoracoscopic repair, with 26 completed. Concurrently, 19 initially open CDH repairs were performed. Preoperatively, patients in the open repair group required more ventilatory support than the thoracoscopic group. Recurrence was higher after thoracoscopic repair (23% vs 0%; P = .032). In comparing successful thoracoscopic repairs to those with recurrence, none of the factors analyzed were predictive of recurrence. Conclusions Early recurrence of hernia is higher in thoracoscopic CDH repairs than in open repairs. Technical factors and a steep learning curve for thoracoscopy may account for the higher recurrence rates, but not patient severity of illness. In an already-tenuous patient population, performing the repair thoracoscopically with a higher risk of recurrence may not be advantageous.

Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis

“…There was very serious risk of bias due to inappropriate patient selection, unequal follow-up durations, and the absence of controlling for confounding. Particularly, selection bias cannot to be ignored; patients who underwent ES were selected by their surgeons or according to facility criteria in six of the studies [16][17][18][19][20][21]. Therefore, the ES groups potentially included milder cases, as compared with the OS groups.…”

“…After screening the remaining 38 studies based on their full texts, 14 studies were included in the qualitative synthesis [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Furthermore, eight observational studies [14][15][16][17][18][19][20][21] published between 2009 and 2013 were included in the quantitative synthesis ( Fig. 1).…”

“…The eight observational studies were included in a quantitative synthesis [14][15][16][17][18][19][20][21]. The eight studies included a total of 4698 patients, of whom 288 belonged to ES groups and 4410 belonged to OS groups.…”

Firstly safety to treatment of morgagni hernia: Transthoracic apporach

“…Bu nedenlerle elektif şartlarda yapılacak cerrahilerle transtorasik cerrahilerin tercih edilmesi uygun olacaktır. Böylece toraks içe-risine girmiş olan intraabdominal organların redüksiyonu ve diyafram onarımı daha efektif ve kontrollü olarak yapılabilir 14 .…”

“…Torakoskopik tamir sonrası nüks oranları %25 lere kadar yükseldiğini gösteren çalışmalar mevcuttur 16 . Gander ve arknın 14 MH'lerinde torakoskopik ve açık cerrahi girişimlerin karşılaştırıldığı çalışmasında torakoskopik olarak tedavi edilen hasta grubunda erken nüks oranlarının, açık cerrahi gruba göre belirgin olarak yüksek bulunduğu bildirilmektedir. Laparoskopi, komplike olmayan MH'lerinde tanıyı doğrula-mak ve tamir amacıyla kullanılabilecek diğer bir yöntemdir.…”