OBSERVATION OF EFFECTIVENESS OF THORACOSCOPIC SURGERY FOR LATEPRESENTING CONGENITAL DIAPHRAGMATIC HERNIA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUANMiao ,  XUChang , XIANGBo , HUANGLugang , JIANGXiaoping , YANGGang

Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

XUChang, Email: xcxcxc52229081@qq.com

Keywords：

Late-presenting congenital diaphragmatic hernia; Thoracoscopy; Minimally invasive surgery; Children

DOI：

10.7507/1002-1892.20160119

Video：

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Objective To explore the effectiveness of thoracoscopic surgery for treating late-presenting congenital diaphragmatic hernias and summarize the experience. Methods Between October 2012 and February 2015, 21 children with late-presenting congenital diaphragmatic hernias underwent thoracoscopic surgery. Of the 21 cases, 12 were girls and 9 were boys with a median age of 1 year and 3 months (range, 2 months to 8 years). Eight patients had obvious symptom in the initial stage:shortness of breath and dyspnea; 13 cases were found occasionally through chest radiography. Of 21 cases, 17 had left diaphragmatic hernias and 4 had right diaphragmatic hernias. The emergency surgery was performed in 5 cases because oppressed obviously and selective operation in 16 cases. Hernial sac existed in 5 cases; there were 19 cases of Bochdalek's hernia and 2 cases of Morgagni's hernia. The size of diaphragmatic defect ranged from 3 cm×2 cm to 5 cm×5 cm. Results The operation time was 35-80 minutes (mean, 50 minutes), and intraoperative blood loss was 3-5 mL (mean, 3.8 mL). Primary healing of incision was obtained. Postoperative abdominal distension and pneumothorax occurred in 12 and 2 cases respectively. The follow-up time was 1-3 years (mean, 20 months). All the cases had a good recovery and satisfactory appearance of the thoracic incision. The symptoms and signs of shortness of breath and dyspnea disappeared. There was no recurrence and chest infection. Conclusion Under the conditions of mastering operative indications strictly, thoracoscopic repair for late-presenting congenital diaphragmatic hernia is safe and feasible. It can facilitate the procedure and decrease the recurrence rate relying on intraoperative application of hernia repair needle, knot pusher-assistant, and reasonable processing defect periphery.

Citation： YUANMiao, XUChang, XIANGBo, HUANGLugang, JIANGXiaoping, YANGGang. OBSERVATION OF EFFECTIVENESS OF THORACOSCOPIC SURGERY FOR LATEPRESENTING CONGENITAL DIAPHRAGMATIC HERNIA. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 590-593. doi: 10.7507/1002-1892.20160119 Copy

1.	Zaleska-Dorobisz U, Baglaj M, Sokolowska B, et al. Late presenting diaphragmatic hernia:clinical and diagnostic aspects. Med Sci Monit, 2007, 13 Suppl 1:137-146.
2.	Baglaj M, Dorobisz U. Late-presenting congenital diaphragmatic hernia in children:a literature review. Pediatr Radiol, 2005, 35(5):478-488.
3.	Heaton ND, Adam G, Howard ER. The late presentation of posterolateral congenital diaphragmatic hernias. Postgrad Med J, 1992, 68(800):445-458.
4.	de Buys Roessingh AS, Dinh-Xuan AT. Congenital diaphragmatic hernia:current status and review of the literature. Eur J Pediatr, 2009, 168(4):393-406.
5.	McHoney M. Congenital diaphragmatic hernia. Early Hum Dev, 2014, 90(12):941-946.
6.	Hollinger LE, Lally PA, Tsao K, et al. A risk-stratified analysis of delayed congenital diaphragmatic hernia repair:does timing of operation matter? Surgery, 2014, 156(2):475-482.
7.	Zani A, Zani-Ruttenstock E, Pierro A. Advances in the surgical approach to congenital diaphragmatic hernia. Semin Fetal Neonatal Med, 2014, 19(6):364-369.
8.	Baglaj M. Late-presenting congenital diaphragmatic hernia in children:a clinical spectrum. Pediatr Surg Int, 2004, 20(9):658-669.
9.	Næss PA, Wiborg J, Kjellevold K, et al. Tension gastrothorax:acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children. Scand J Trauma Resusc Emerg Med, 2015, 6(24):23-49.
10.	Zefov VN, Almatrooshi MA. Chest X-ray findings in lateonset congenital diaphragmatic hernia, a rare emergency easily misdiagnosed as hydropneumothorax:a case report. J Med Case Rep, 2015, 9(1):291.
11.	Ozkan A, Bozkurter Cil AT, Kaya M, et al. Late presenting bochdalek hernia with gastric perforation. Pediatr Emerg Care, 2015, 31(1):47-49.
12.	胡廷泽, 徐志诚, 刘文英, 等. 新生儿及婴幼儿胸腹裂孔疝诊治的临床特点. 中国修复重建外科杂志, 2007, 21(7):722-725.
13.	McHoney M, Giacomello L, Nah SA, et al. Thoracoscopic repair of congenital diaphragmatic hernia:intraoperative ventilation and recurrence. J Pediatr Surg, 2010, 45(2):355-359.
14.	Chan E, Wayne C, Nasr A. Minimally invasive versus open repair of Bochdalek hernia:a meta-analysis. J Pediatr Surg, 2014, 49(5):694-699.
15.	Tsao K, Lally PA, Lally KP, et al. Minimally invasive repair of congenital diaphragmatic hernia. J Pediatr Surg, 2011, 46(6):1158-1164.
16.	钟微, 何秋明, 夏慧敏. 先天性膈疝生后手术治疗的演变与评价. 中国微创外科杂志, 2015, 15(7):655-657, 669.
17.	黄金狮, 陈快, 戴康临, 等. 经胸腔镜手术治疗先天性膈疝的体会. 中华小儿外科杂志, 2012, 33(5):340-343.
18.	Arca MJ, Barnhart DC, Lelli JL Jr, et al. Early experience with minimally invasive repair of congenital diaphragmatic hernias:results and lessons learned. J Pediatr Surg, 2003, 38(11):1563-1568.
19.	Becmeur F, Reinberg O, Dimitriu C, et al. Thoracoscopic repair of congenital diaphragmatic hernia in children. Semin Pediatr Surg, 2007, 16(4):238-244.
20.	Rygl M, Rounova P, Sulc J, et al. Abnormalities in pulmonary function in infants with high-risk congenital diaphragmatic hernia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2015, 159(3):497-502.
21.	Munevver H, Irfan K, Aytac K, et al. Associated malformations in delayed presentation of congenital diaphragmatic hernia. J Pediatr Surg, 2004, 39(7):1073-1076.
22.	Sulhyan KR, Ramteerthakar NA, Gosavi AV, et al. Extralobar sequestration of lung associated with congenital diaphragmatic hernia and malrotation of gut. Lung India, 2015, 32(4):381-383.
23.	Choe J, Goo HW. Extralobar pulmonary sequestration with hemorrhagic infarction in a child:preoperative imaging diagnosis and pathological correlation. Korean J Radiol, 2015, 16(3):662-667.
24.	Baerg J, Kanthimathinathan V, Gollin G. Late-presenting congenital diaphragmatic hernia:diagnostic pitfalls and outcome. Hernia, 2012, 16(4):461-466.

1. Zaleska-Dorobisz U, Baglaj M, Sokolowska B, et al. Late presenting diaphragmatic hernia:clinical and diagnostic aspects. Med Sci Monit, 2007, 13 Suppl 1:137-146.
2. Baglaj M, Dorobisz U. Late-presenting congenital diaphragmatic hernia in children:a literature review. Pediatr Radiol, 2005, 35(5):478-488.
3. Heaton ND, Adam G, Howard ER. The late presentation of posterolateral congenital diaphragmatic hernias. Postgrad Med J, 1992, 68(800):445-458.
4. de Buys Roessingh AS, Dinh-Xuan AT. Congenital diaphragmatic hernia:current status and review of the literature. Eur J Pediatr, 2009, 168(4):393-406.
5. McHoney M. Congenital diaphragmatic hernia. Early Hum Dev, 2014, 90(12):941-946.
6. Hollinger LE, Lally PA, Tsao K, et al. A risk-stratified analysis of delayed congenital diaphragmatic hernia repair:does timing of operation matter? Surgery, 2014, 156(2):475-482.
7. Zani A, Zani-Ruttenstock E, Pierro A. Advances in the surgical approach to congenital diaphragmatic hernia. Semin Fetal Neonatal Med, 2014, 19(6):364-369.
8. Baglaj M. Late-presenting congenital diaphragmatic hernia in children:a clinical spectrum. Pediatr Surg Int, 2004, 20(9):658-669.
9. Næss PA, Wiborg J, Kjellevold K, et al. Tension gastrothorax:acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children. Scand J Trauma Resusc Emerg Med, 2015, 6(24):23-49.
10. Zefov VN, Almatrooshi MA. Chest X-ray findings in lateonset congenital diaphragmatic hernia, a rare emergency easily misdiagnosed as hydropneumothorax:a case report. J Med Case Rep, 2015, 9(1):291.
11. Ozkan A, Bozkurter Cil AT, Kaya M, et al. Late presenting bochdalek hernia with gastric perforation. Pediatr Emerg Care, 2015, 31(1):47-49.
12. 胡廷泽, 徐志诚, 刘文英, 等. 新生儿及婴幼儿胸腹裂孔疝诊治的临床特点. 中国修复重建外科杂志, 2007, 21(7):722-725.
13. McHoney M, Giacomello L, Nah SA, et al. Thoracoscopic repair of congenital diaphragmatic hernia:intraoperative ventilation and recurrence. J Pediatr Surg, 2010, 45(2):355-359.
14. Chan E, Wayne C, Nasr A. Minimally invasive versus open repair of Bochdalek hernia:a meta-analysis. J Pediatr Surg, 2014, 49(5):694-699.
15. Tsao K, Lally PA, Lally KP, et al. Minimally invasive repair of congenital diaphragmatic hernia. J Pediatr Surg, 2011, 46(6):1158-1164.
16. 钟微, 何秋明, 夏慧敏. 先天性膈疝生后手术治疗的演变与评价. 中国微创外科杂志, 2015, 15(7):655-657, 669.
17. 黄金狮, 陈快, 戴康临, 等. 经胸腔镜手术治疗先天性膈疝的体会. 中华小儿外科杂志, 2012, 33(5):340-343.
18. Arca MJ, Barnhart DC, Lelli JL Jr, et al. Early experience with minimally invasive repair of congenital diaphragmatic hernias:results and lessons learned. J Pediatr Surg, 2003, 38(11):1563-1568.
19. Becmeur F, Reinberg O, Dimitriu C, et al. Thoracoscopic repair of congenital diaphragmatic hernia in children. Semin Pediatr Surg, 2007, 16(4):238-244.
20. Rygl M, Rounova P, Sulc J, et al. Abnormalities in pulmonary function in infants with high-risk congenital diaphragmatic hernia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2015, 159(3):497-502.
21. Munevver H, Irfan K, Aytac K, et al. Associated malformations in delayed presentation of congenital diaphragmatic hernia. J Pediatr Surg, 2004, 39(7):1073-1076.
22. Sulhyan KR, Ramteerthakar NA, Gosavi AV, et al. Extralobar sequestration of lung associated with congenital diaphragmatic hernia and malrotation of gut. Lung India, 2015, 32(4):381-383.
23. Choe J, Goo HW. Extralobar pulmonary sequestration with hemorrhagic infarction in a child:preoperative imaging diagnosis and pathological correlation. Korean J Radiol, 2015, 16(3):662-667.
24. Baerg J, Kanthimathinathan V, Gollin G. Late-presenting congenital diaphragmatic hernia:diagnostic pitfalls and outcome. Hernia, 2012, 16(4):461-466.

Chinese Journal of Reparative and Reconstructive Surgery

OBSERVATION OF EFFECTIVENESS OF THORACOSCOPIC SURGERY FOR LATEPRESENTING CONGENITAL DIAPHRAGMATIC HERNIA

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