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

摘要: Minimally invasive surgery (MIS) for late-presenting congenital diaphragmatic hernia (CDH) has been described previously, but few neonatal cases of CDH have reported. This study aimed to report the multicenter experience these rare and compare laparoscopic thoracoscopic approaches. Using MIS procedures, 30 patients (16 boys 14 girls) from nine centers underwent within first month life, 26 before day 5. Only one patient had associated malformations. There were 10 preterm (32–36 weeks gestational age). Their weight at birth ranged 1,800 3,800 g, with three weighing less than 2,600 g. Of patients, 18 intubated birth. The procedures performed in by a approach 12 approach. No severe complication was observed. For 20 reduction intrathoracic contents achieved easily 15 thoracoscopies 5 laparoscopies. In six cases, difficult, proving be impossible four remaining patients: treated thoracoscopy laparoscopy. reasons inability reduce thoracic difficulty liver mobilization (1 left 2 right CDH) presence dilated stomach thorax. Reductions easier wide defects using thoracoscopy. conversions (5 laparoscopies thoracoscopies). reported conversion (n = 4), need patch (n = 5), lack adequate vision narrow working space (n = 1), bowel malrotation an anesthetic problem (n = 1). Five too large direct closure closed patch. Four required conversion, through video-assisted surgery. recurrences detected after two primer closures, which managed successful reoperation period, can safely procedures. overall success rate this 67%. indication is not related weeks age, (if >2,600 g), or extent immediate care. Patients no anomaly who are hemodynamically stabilized benefit Reduction herniated organs Right CDH, lobe herniation, most frequent conversion.