Top

Published in:

01-03-2016

Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy

Authors: Mikihiro Inoue, Keiichi Uchida, Kohei Otake, Yuka Nagano, Koichiro Mori, Kiyoshi Hashimoto, Kohei Matsushita, Yuhki Koike, Aki Uemura, Masato Kusunoki

Published in: Surgical Endoscopy | Issue 3/2016

Abstract

Background

Thoracoscopic repair is the preferred treatment for congenital diaphragmatic hernia (CDH); however, several complications, including visceral injury, hypercapnia, and a high incidence of recurrence, have been reported. The purpose of this study was to evaluate the efficacy of countermeasures against these complications at ensuring safe thoracoscopic repair.

Methods

Between January 2000 and December 2014, 40 patients with Bochdalek-type CDH were treated. Of these, 24 patients met the defined criteria for this study, 8 of whom underwent thoracoscopic repair beginning in January 2010 (TS group) and 16 underwent laparotomy before December 2009 (LT group). Perioperative variables and postoperative complications were compared between the groups. Countermeasures against adverse events in the TS group included an endoscopic surgical spacer to prevent visceral injury, intrapulmonary percussive ventilation to avoid hypercapnia, pausing CO₂ insufflation to reduce tension during the repair, and prioritizing patch repair in cases of strong tension at the defect.

Results

Primary closure was performed in 4 of 8 cases in the TS and 11 of 16 cases in the LT group. There was no visceral injury or conversion to laparotomy in the TS group. The mean operative duration was significantly longer (212 vs. 115 min, respectively, p = 0.0001), and the mean blood loss was significantly less in the TS than in the LT group (1.0 vs. 10.1 mL, respectively, p = 0.01). The intraoperative minimum arterial pH and maximum pCO₂ were similar between the groups. All patients survived, and none experienced recurrence.

Conclusions

Our countermeasures to complications of thoracoscopic repair may contribute to safe outcomes equivalent to those of laparotomy in patients meeting our criteria.

Silen ML, Canvasser DA, Kurkchubasche AG, Andrus CH, Naunheim KS (1995) Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia. Ann Thorac Surg 60:448–450CrossRefPubMed

Arca MJ, Barnhart DC, Lelli JL Jr, Greenfeld J, Harmon CM, Hirschl RB, Teitelbaum DH (2003) Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg 38:1563–1568CrossRefPubMed

Cho SD, Krishnaswami S, Mckee JC, Zallen G, Silen ML, Bliss DW (2009) Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls. J Pediatr Surg 44:80–86CrossRefPubMed

Okazaki T, Nishimura K, Takahashi T, Shoji H, Shimizu T, Tanaka T, Takeda S, Inada E, Lane GJ, Yamataka A (2011) Indications for thoracoscopic repair of congenital diaphragmatic hernia in neonates. Pediatr Surg Int 27:35–38CrossRefPubMed

Becmeur F, Reinberg O, Dimitriu C, Moog R, Philippe P (2007) Thoracoscopic repair of congenital diaphragmatic hernia in children. Semin Pediatr Surg 16:238–244CrossRefPubMed

McHoney M, Giacomello L, Nah SA, De Coppi P, Kiely EM, Curry JI, Drake DP, Eaton S, Pierro A (2010) Thoracoscopic repair of congenital diaphragmatic hernia: intraoperative ventilation and recurrence. J Pediatr Surg 45:355–359CrossRefPubMed

Jancelewicz T, Langer JC, Chiang M, Bonnard A, Zamakhshary M, Chiu PP (2013) Thoracoscopic repair of neonatal congenital diaphragmatic hernia (CDH): outcomes after a systematic quality improvement process. J Pediatr Surg 48:321–325CrossRefPubMed

Gander JW, Fisher JC, Gross ER, Reichstein AR, Cowles RA, Aspelund G, Stolar CJ, Kuenzler KA (2011) Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study. J Pediatr Surg 46:1303–1308PubMedCentralCrossRefPubMed

Gourlay DM, Cassidy LD, Sato TT, Lal DR, Arca MJ (2009) Beyond feasibility: a comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias. J Pediatr Surg 44:1702–1707CrossRefPubMed

10.

Keijzer R, van de Ven C, Vlot J, Sloots C, Madern G, Tibboel D, Bax K (2010) Thoracoscopic repair in congenital diaphragmatic hernia: patching is safe and reduces the recurrence rate. J Pediatr Surg 45:953–957CrossRefPubMed

11.

Shah SR, Wishnew J, Barsness K, Gaines BA, Potoka DA, Gittes GK, Kane TD (2009) Minimally invasive congenital diaphragmatic hernia repair: a 7-year review of one institution’s experience. Surg Endosc 23:1265–1271CrossRefPubMed

12.

Yang EY, Allmendinger N, Johnson SM, Chen C, Wilson JM, Fishman SJ (2005) Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome. J Pediatr Surg 40:1369–1375CrossRefPubMed

13.

Nguyen TL, Le AD (2006) Thoracoscopic repair for congenital diaphragmatic hernia: lessons from 45 cases. J Pediatr Surg 41:1713–1715CrossRefPubMed

14.

Al-Jazaeri A (2012) Simplified technique for minimally invasive repair of congenital diaphragmatic hernia using hollow-needle snare and transthoracic traction stitches. J Pediatr Surg 47:258–263CrossRefPubMed

15.

Ellinas H, Seefelder C (2010) Congenital diaphragmatic hernia repair in neonates: Is thoracoscopy feasible? Paediatr Anaesth 20:967–969CrossRefPubMed

16.

Gomes Ferreira C, Reinberg O, Becmeur F, Allal H, De Lagausie P, Lardy H, Philippe P, Lopez M, Varlet F, Podevin G, Schleef J, Schlobach M (2009) Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy. Surg Endosc 23:1650–1659CrossRefPubMed

17.

Gupta RK, Parelkar SV, Oak SN, Sanghvi B, Prakash A, Bachani M, Patil R (2011) Early experience with thoracoscopic repair of congenital diaphragmatic hernias in pediatric age group: results and lessons learned. Pediatr Surg Int 27:563–566CrossRefPubMed

18.

Said SM, Moir CR, Ishitani MB, Zarroug AE (2010) Successful thoracoscopic staged repair of bilateral congenital diaphragmatic hernia. J Pediatr Surg 45:E5–E8CrossRefPubMed

19.

Nam SH, Cho MJ, Kim DY, Kim SC (2013) Shifting from laparotomy to thoracoscopic repair of congenital diaphragmatic hernia in neonates: early experience. World J Surg 37:2711–2716CrossRefPubMed

20.

Gomes Ferreira C, Kuhn P, Lacreuse I, Kasleas C, Philippe P, Podevin G, Bonnard A, Lopez M, De Lagausie P, Petit T, Lardy H, Becmeur F (2013) Congenital diaphragmatic hernia: an evaluation of risk factors for failure of thoracoscopic primary repair in neonates. J Pediatr Surg 48:488–495CrossRefPubMed

21.

Fishman JR, Blackburn SC, Jones NJ, Madden N, De Caluwe D, Haddad MJ, Clarke SA (2011) Does thoracoscopic congenital diaphragmatic hernia repair cause a significant intraoperative acidosis when compared to an open abdominal approach? J Pediatr Surg 46:458–461CrossRefPubMed

22.

Bishay M, Giacomello L, Retrosi G, Thyoka M, Nah SA, McHoney M, De Coppi P, Brierley J, Scuplak S, Kiely EM, Curry JI, Drake DP, Cross KM, Eaton S, Pierro A (2011) Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants. J Pediatr Surg 46:47–51CrossRefPubMed

23.

Bishay M, Giacomello L, Retrosi G, Thyoka M, Garriboli M, Brierley J, Harding L, Scuplak S, Cross KM, Curry JI, Kiely EM, De Coppi P, Eaton S, Pierro A (2013) Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg 258:895–900CrossRefPubMed

24.

Johnson LS, DeMeester TR (1974) Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332PubMed

25.

Inoue M, Uchida K, Otake K, Ishino Y, Koike Y, Kusunoki M (2012) Use of endoscopic surgical spacer to improve safety during thoracoscopic repair of congenital diaphragmatic hernia. J Laparoendosc Adv Surg Tech A 22:304–306CrossRefPubMed

26.

Ravez P, Richez M, Godart G, Vanthiel J, Gauchet P, Robience YJ (1986) Effect of intermittent high-frequency intrapulmonary percussive breathing on mucus transport. Eur J Respir Dis Suppl 146:285–289PubMed

27.

Deakins K, Chatburn RL (2002) A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy for the treatment of atelectasis in the pediatric patient. Respir Care 47:1162–1167PubMed

28.

Homnick DN, White F, de Castro C (1995) Comparison of effects of an intrapulmonary percussive ventilator to standard aerosol and chest physiotherapy in treatment of cystic fibrosis. Pediatr Pulmonol 20:50–55CrossRefPubMed

29.

Reardon CC, Christiansen D, Barnett ED, Cabral HJ (2005) Intrapulmonary percussive ventilation vs incentive spirometry for children with neuromuscular disease. Arch Pediatr Adolesc Med 159:526–531CrossRefPubMed

30.

Paviotti G, Bua J, De Cunto A, Travan L, Demarini S (2014) High-frequency percussive ventilation as rescue treatment in severe hypoxemic respiratory failure in term neonates. J Crit Care 29:662–663CrossRefPubMed

31.

Vanamo K, Rintala RJ, Lindahl H, Louhimo I (1996) Long-term gastrointestinal morbidity in patients with congenital diaphragmatic defects. J Pediatr Surg 31:551–554CrossRefPubMed

32.

Inoue M, Uchida K, Otake K, Nagano Y, Ide S, Hashimoto K, Matsushita K, Koike Y, Mohri Y, Kusunoki M (2013) Efficacy of Seprafilm for preventing adhesive bowel obstruction and cost-benefit analysis in pediatric patients undergoing laparotomy. J Pediatr Surg 48:1528–1534CrossRefPubMed

Title: Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy
Authors: Mikihiro Inoue
Keiichi Uchida
Kohei Otake
Yuka Nagano
Koichiro Mori
Kiyoshi Hashimoto
Kohei Matsushita
Yuhki Koike
Aki Uemura
Masato Kusunoki
Publication date: 01-03-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4287-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2016

Role of laparoscopic ultrasound during diagnostic laparoscopy for proximal biliary cancers: a single series of 100 patients

Avoiding colorectal resection for polyps: is CELS the best method?

Development and implementation of the Structured Training Trainer Assessment Report (STTAR) in the English National Training Programme for laparoscopic colorectal surgery

Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection

SAGES Assessment on the da Vinci® Surgical System

Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: a review of 168,248 cases