Thoracoscopic repair of congenital diaphragmatic hernia by inflation-assisted bowel reduction, in a resuscitated neonate: a better access?

Abstract

Elective endoscopic diaphragmatic hernia repairs have been reported. But endoscopic surgery was regarded unsuitable for emergency repair of diaphragmatic hernia in ventilated newborn children in bad general condition. We report a new method for inflation-assisted reduction and thoracoscopic repair of congenital diaphragmatic hernia diaphragmatic in a vitally endangered neonate. From three 2.7 mm to 5 mm accesses warmed low-pressure, low-volume CO2 was inflated into the thorax at 100 ml/min and 2 mm mercury. This allowed spontaneous reduction of the thoracic viscera into the abdomen and diaphragmatic suture with minimal handling. The 65-min procedure was tolerated well without perioperative deterioration. The baby was weaned off the respirator and breast-fed within 2 days, mediastinal shift normalized in 6 days. In suitable infants thoracoscopic repair and inflation-assisted reduction of thoracic contents is a more physiological access to congenital diaphragmatic hernia than laparoscopy or laparotomy.

Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study

“…Schaarschmidt et al [12] reported a technique in which a thoracoscopic inflation-assisted reduction of the thoracic contents was performed. These authors further state that this technique offers a more physiologic access to congenital diaphragmatic hernia than laparoscopy or laparotomy.…”

Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy

“…Ever since these first reports, the benefits of MIS for late-presenting CDH have been described, but very few neonatal cases have been reported [5][6][7][8][9][10][11][12]. The use of MIS for those fragile patients remains controversial.…”

Laparoscopic dual mesh repair of a diaphragmatic hernia of Bochdalek in a symptomatic elderly patient

“…Depending on the surgeon's experience, diaphragmatic hernia repair can be performed by laparoscopy through the chest or the abdomen, by a combined approach of both techniques described by Esmer or just by a thoracoscopic inflation-assisted reduction of the thoracic contents as reported by Schaarschmidt [18,19].…”