Laparoscopic Transperitoneal Repair of Pediatric Diaphragm Eventration Using an Endostapler Device

Abstract

Background: Minimally invasive repairs of pediatric diaphragm eventration have been well described via a thoracoscopic approach, oftentimes requiring single-lung ventilation and tube thoracostomy, with the disadvantage of not being able to clearly visualize what lies beneath the diaphragm. We describe a novel pediatric diaphragm eventration repair using a laparoscopic transperitoneal approach and an endostapler device. We also describe our initial experience with this technique. Patients and Methods: Four pediatric diaphragmatic eventration patients underwent laparoscopic transperitoneal repair using an endostapler device. Repairs were performed in both male and female patients with rightsided eventrations. We approach the repair in a transperitoneal fashion using inverting sutures at the apex of the diaphragm to create tension toward the pelvis. Subsequently, an endostapler is used to remove the redundant portion of diaphragm, leaving a repaired, taut diaphragm. Results: The median age at operation was 10.5 months. The median operative time was 70 minutes. There was no mortality, surgical complications, or recurrence at a median follow-up of 17 months. Conclusions: This laparoscopic approach allows for clear visualization of the intraabdominal organs and, at least in our early experience, a very simple, straightforward operation. Additionally, with the use of the endostapler, the redundant, often weakened diaphragm is removed, leaving the native, healthy diaphragm behind, resulting in a reliable and reproducible repair. This repair should be considered as a feasible alternative approach to the more traditional open and thoracoscopic repairs.

Thoracic versus abdominal approach to correct diaphragmatic eventration in children

“…Paediatric surgeons, over the years, have taken advantage of this fact and successfully approached it through the chest as well as the abdomen, beginning with open surgical procedures and moving on to minimally invasive techniques as technology has advanced. Majority of the literature on paediatric DE repair describes personal or single institutional experiences using one approach or the other [12][13][14][15][16][17][18][19][20][21][22][23][24] with limited number of multicentric studies [25,26]. Pros and cons of each of these approaches have been clearly defined by various adult and paediatric studies but there is no consensus regarding 'best practice'.…”

A Rare Case of Contralateral Diaphragm Paralysis following Birth Injury with Brachial Plexus Palsy: A Case Report and Review of the Literature

“…Another option for repair is a laparoscopic approach, theorizing that patients tolerate laparoscopy better than thoracoscopy, as well as the surgeon having more working room in the abdomen as compared to the thorax. Laparoscopic diaphragm plication is well-tolerated in the pediatric population, so operative approach should be determined on a case-by-case basis considering the patient history, laterality, and the experience and comfort level of the surgeon [ 21 , 22 ].…”

Thoracoscopic diaphragmatic plication with endostapler

“…[6][7][8] Ameliyat sonrası dönemde stapler hattında açılmaya bağlı komplikasyon oluşumunu önlemek ya da ek güven-lik tedbiri almak açısından stapler hattının emilmeyen dikişler ile desteklenmesini öneren yayınlar [9] olsa da, stapler hattı üzerinden sütürasyonu iki nedenden dolayı gerekli görmemekteyiz. İlk olarak diyaframda oluşan gerginlik nedeni ile atılacak her sütür diyaframda yırtıl-malara neden olabilecektir.…”