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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2016

Open Access 01-07-2016

Thoracoscopic versus open repair of CDH in cardiovascular stable neonates

Authors: Sophie Costerus, Katrin Zahn, Kees van de Ven, John Vlot, Lucas Wessel, Rene Wijnen

Published in: Surgical Endoscopy | Issue 7/2016

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Abstract

Background

Thoracoscopic surgery is an increasingly popular surgical technique to repair congenital diaphragmatic hernia (CDH). However, acidosis during surgery and the higher recurrence rate are considerable risk factors. The aim of this retrospective study is to compare the outcome of open versus thoracoscopic repair of the diaphragm in neonates with CDH with the same degree of cardiovascular and pulmonary illness who meet the criteria for thoracoscopic repair.

Methods

Retrospective analysis of all patients of two large national reference centers for CDH born in the years 2008 through 2012, and meeting the criteria for surgical repair on cardiopulmonary and physiological criteria according to the CDH EURO consortium consensus and meeting the criteria for thoracoscopic repair according to the review by Vijfhuize et al. The surgical technical aspects were comparable in both centers.

Results

108 patients were included, of whom 75 underwent thoracoscopic repair and 34 underwent open repair. The gestational age and lung-to-head ratio were significantly lower and stay on the ICU significantly longer in the open-repair group. The operation time was longer (178 vs. 150 min, p = .012) and the recurrence rate higher (18.9 vs. 5.9 %, p = .036) in the thoracoscopic-repair group. The arterial pH, pO2, pCO2 and base excess before and after thoracoscopic repair were all significantly different.

Conclusion

After critical selection for thoracoscopic repair of left-sided CDH based on the patient’s preoperative condition, the outcomes of open repair were almost identical to those of thoracoscopic repair. A notable exception is the recurrence rate, which was significantly higher in the thoracoscopic-repair group. For the time being, thoracoscopic primary closure seems a safe and effective procedure, but efficacy of thoracoscopic patch repair has not been established.
Literature
1.
Downard CD, Jaksic T, Garza JJ, Dzakovic A, Nemes L, Jennings RW, Wilson JM (2003) Analysis of an improved survival rate for congenital diaphragmatic hernia. J Pediatr Surg 38:729–732CrossRefPubMed
2.
Lally KP, Lasky RE, Lally PA, Bagolan P, Davis CF, Frenckner BP, Hirschl RM, Langham MR, Buchmiller TL, Usui N, Tibboel D, Wilson JM, Congenital Diaphragmatic Hernia Study G (2013) Standardized reporting for congenital diaphragmatic hernia—an international consensus. J Pediatr Surg 48:2408–2415CrossRefPubMed
3.
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
4.
Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst A, Gorett Silva M, Greenough A, Tibboel D, Consortium CE (2010) Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology 98:354–364CrossRefPubMed
5.
6.
Vijfhuize S, Deden AC, Costerus SA, Sloots CE, Wijnen RM (2012) Minimal access surgery for repair of congenital diaphragmatic hernia: is it advantageous? An open review. Eur J Pediatric Surg 22:364–373CrossRef
7.
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
8.
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
9.
Lao OB, Crouthamel MR, Goldin AB, Sawin RS, Waldhausen JH, Kim SS (2010) Thoracoscopic repair of congenital diaphragmatic hernia in infancy. J Laparoendosc Adv Surg Tech Part A 20:271–276CrossRef
10.
Ceelie I, van Dijk M, Bax NM, de Wildt SN, Tibboel D (2011) Does minimal access major surgery in the newborn hurt less? An evaluation of cumulative opioid doses. Eur J Pain 15:615–620CrossRefPubMed
11.
Blobner M, Bogdanski R, Kochs E, Henke J, Findeis A, Jelen-Esselborn S (1998) Effects of intraabdominally insufflated carbon dioxide and elevated intraabdominal pressure on splanchnic circulation: an experimental study in pigs. Anesthesiology 89:475–482CrossRefPubMed
12.
Caldwell CB, Ricotta JJ (1987) Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 43:14–20CrossRefPubMed
13.
Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, Buchler MW (2004) Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 21:95–105CrossRefPubMed
14.
Ishizaki Y, Bandai Y, Shimomura K, Abe H, Ohtomo Y, Idezuki Y (1993) Changes in splanchnic blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide. Surg Endosc 7:420–423CrossRefPubMed
15.
Jakimowicz J, Stultiens G, Smulders F (1998) Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 12:129–132CrossRefPubMed
16.
Nickkholgh A, Barro-Bejarano M, Liang R, Zorn M, Mehrabi A, Gebhard MM, Buchler MW, Gutt CN, Schemmer P (2008) Signs of reperfusion injury following CO2 pneumoperitoneum: an in vivo microscopy study. Surg Endosc 22:122–128CrossRefPubMed
17.
Ure BM, Suempelmann R, Metzelder MM, Kuebler J (2007) Physiological responses to endoscopic surgery in children. Semin Pediatr Surg 16:217–223CrossRefPubMed
18.
Tsao K, Lally PA, Lally KP, Congenital Diaphragmatic Hernia Study G (2011) Minimally invasive repair of congenital diaphragmatic hernia. J Pediatr Surg 46:1158–1164CrossRefPubMed
19.
Loff S, Wirth H, Jester I, Hosie S, Wollmann C, Schaible T, Ataman O, Waag KL (2005) Implantation of a cone-shaped double-fixed patch increases abdominal space and prevents recurrence of large defects in congenital diaphragmatic hernia. J Pediatr Surg 40:1701–1705CrossRefPubMed
20.
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
21.
Szavay PO, Obermayr F, Maas C, Luenig H, Blumenstock G, Fuchs J (2012) Perioperative outcome of patients with congenital diaphragmatic hernia undergoing open versus minimally invasive surgery. J Laparoendosc Adv Surg Tech Part A 22:285–289CrossRef
22.
Ben-Haim M, Rosenthal RJ (1999) Causes of arterial hypertension and splachnic ischemia during acute elevations in intra-abdominal pressure with CO2 pneumoperitoneum: a complex central nervous system mediated response. Int J Colorectal Dis 14:227–236CrossRefPubMed
23.
Schilling MK, Redaelli C, Krahenbuhl L, Signer C, Buchler MW (1997) Splanchnic microcirculatory changes during CO2 laparoscopy. J Am Coll Surg 184:378–382PubMed
24.
Imamoglu M, Cay A, Unsal MA, Aydin S, Ozdemir O, Karahan C, Sari A, Sarihan H (2006) The effects of increased intraabdominal pressure on testicular blood flow, oxidative stress markers, and morphology. J Pediatr Surg 41:1118–1124CrossRefPubMed
25.
Polat C, Arikan Y, Vatansev C, Akbulut G, Yilmaz S, Dilek FH, Gokce O (2002) The effects of increased intraabdominal pressure on colonic anastomoses. Surg Endosc 16:1314–1319CrossRefPubMed
26.
Pollock JM, Deibler AR, Whitlow CT, Tan H, Kraft RA, Burdette JH, Maldjian JA (2009) Hypercapnia-induced cerebral hyperperfusion: an underrecognized clinical entity. AJNR Am J Neuroradiol 30:378–385CrossRefPubMed
27.
28.
Mortellaro VE, Fike FB, Adibe OO, Juang D, Aguayo P, Ostlie DJ, Holcomb GW, St Peter SD (2011) The use of high-frequency oscillating ventilation to facilitate stability during neonatal thoracoscopic operations. J Laparoendosc Adv Surg Tech Part A 21:877–879CrossRef
Metadata
Title
Thoracoscopic versus open repair of CDH in cardiovascular stable neonates
Authors
Sophie Costerus
Katrin Zahn
Kees van de Ven
John Vlot
Lucas Wessel
Rene Wijnen
Publication date
01-07-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4560-8

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