There are currently no general guidelines on the selection criteria for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) in neonates, and some patients who are not suitable for the thoracoscopic approach have to be converted to open repair (OR) after undergoing initial thoracoscopy. The aim of this study was to evaluate factors associated with conversion to OR during TR of neonatal cases of CDH and to explore countermeasures against conversion. Medical records of neonates who underwent thoracoscopy for Bochdalek-type CDH at a tertiary center from January 2013 to July 2019 were retrospectively reviewed. We defined two groups: the T group included neonates undergoing complete TR and the TO group included neonates requiring conversion to OR during TR. Thoracoscopy was performed in 58 neonates, with 48 in T group and 10 in TO group. The conversion rate was 17.2%. The proportion of patients with diaphragmatic defect size greater than 6 cm x 5 cm was significantly higher in the TO group than in the T group (30% vs. 2.08%; p = 0.014). The rate of patch use was significantly higher in the TO group compared to the T group (30% vs. 4.17%; p = 0.032). There was no statistically significant difference between the two groups in terms of stomach herniation or liver herniation. The postoperative recurrence rate was 17.78% in the T group and 0% in the TO group (p = 0.39). Defect size greater than 6 cm x 5 cm and patch use were associated with higher conversion rate, while stomach herniation and liver herniation were not. Patients who require conversion but are not actually converted to open repair may have a higher risk of postoperative recurrence.
| Published in | American Journal of Pediatrics (Volume 8, Issue 3) |
| DOI | 10.11648/j.ajp.20220803.11 |
| Page(s) | 152-157 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Congenital Diaphragmatic Hernia, Thoracoscopy, Conversion to Open Surgery, Neonate
| [1] | Dingeldein M (2018) Congenital diaphragmatic hernia: management & outcomes. Adv Pediatr 65: 241-247. https://doi.org/10.1016/j.yapd.2018.05.001 |
| [2] | Chandrasekharan PK, Rawat M, Madappa R, Rothstein DH, Lakshminrusimha S (2017) Congenital diaphragmatic hernia - a review. Matern Health Neonatol Perinatol 3: 6. https://doi.org/10.1186/s40748-017-0045-1 |
| [3] | 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: 448-450. https://doi.org/10.1016/0003-4975(95)00100-y |
| [4] | Becmeur F, Jamali RR, Moog R, Keller L, Christmann D, Donato L, Kauffmann I, Schwaab C, Carrenard G, Sauvage P (2001) Thoracoscopic treatment for delayed presentation of congenital diaphragmatic hernia in the infant. A report of three cases. Surg Endosc 15: 1163-1166. https://doi.org/10.1007/s004640090064 |
| [5] | Liem NT (2003) Thoracoscopic surgery for congenital diaphragmatic hernia: A report of nine cases. Asian J Surg 26: 210-212. https://doi.org/10.1016/S1015-9584(09)60305-5 |
| [6] | Qin J, Ren Y, Ma D (2019) A comparative study of thoracoscopic and open surgery of congenital diaphragmatic hernia in neonates. J Cardiothorac Surg 14: 118. https://doi.org/10.1186/s13019-019-0938-3 |
| [7] | Fujishiro J, Ishimaru T, Sugiyama M, Arai M, Suzuki K, Kawashima H, Iwanaka T (2016). Minimally invasive surgery for diaphragmatic diseases in neonates and infants. Surg Today 46: 757-763. https://doi.org/10.1007/s00595-015-1222-3 |
| [8] | 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: 895-900. https://doi.org/10.1097/SLA.0b013e31828fab55 |
| [9] | Puligandla PS, Grabowski J, Austin M, Hedrick H, Renaud E, Arnold M, Williams RF, Graziano K, Dasgupta R, McKee M, Lopez ME, Jancelewicz T, Goldin A, Downard CD, Islam S (2015) Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee. J Pediatr Surg 50: 1958-1970. https://doi.org/10.1016/j.jpedsurg.2015.09.010 |
| [10] | Wagner R, Mayer S, Feng X, Gosemann JH, Zimmermann P, Lacher M (2020) Thoracoscopic Repair of Congenital Diaphragmatic Hernia. Eur J Pediatr Surg 30: 137-141. https://doi.org/10.1055/s-0040-1702222 |
| [11] | Lacher M, St Peter SD, Laje P, Harmon CM, Ure B, Kuebler JF (2015) Thoracoscopic CDH repair--a survey on opinion and experience among IPEG members. J Laparoendosc Adv Surg Tech A 25: 954-957. https://doi.org/10.1089/lap.2015.0243 |
| [12] | 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: 488-495. https://doi.org/10.1016/j.jpedsurg.2012.09.060 |
| [13] | Okazaki T, Okawada M, Koga H, Miyano G, Doi T, Ogasawara Y, Yamataka A (2016) Congenital diaphragmatic hernia in neonates: factors related to failure of thoracoscopic repair. Pediatr Surg Int 32: 933-937. https://doi.org/10.1007/ s00383-016-3947-5 |
| [14] | Weaver KL, Baerg JE, Okawada M, Miyano G, Barsness KA, Lacher M, Gonzalez DO, Minneci PC, Perger L, St Peter SD (2016) A Multi-Institutional Review of Thoracoscopic Congenital Diaphragmatic Hernia Repair. J Laparoendosc Adv Surg Tech A 26: 825-830. https://doi.org/10.1089/lap.2016.0358 |
| [15] | Kamran A, Zendejas B, Demehri FR, Nath B, Zurakowski D, Smithers CJ (2018) Risk factors for recurrence after thoracoscopic repair of congenital diaphragmatic hernia (CDH). J Pediatr Surg 53: 2087-2091. https://doi.org/10.1016/j.jpedsurg.2018.04.007 |
| [16] | Okawada M, Ohfuji S, Yamoto M, Urushihara N, Terui K, Nagata K, Taguchi T, Hayakawa M, Amari S, Masumoto K, Okazaki T, Inamura N, Toyoshima K, Inoue M, Furukawa T, Yokoi A, Kanamori Y, Usui N, Tazuke Y, Saka R, Okuyama H, Japanese Congenital Diaphragmatic Hernia Study Group (2021). Thoracoscopic repair of congenital diaphragmatic hernia in neonates: findings of a multicenter study in Japan. Surg Today 51: 1694-1702. https://doi.org/10.1007/s00595-021-02278-6 |
| [17] | Bawazir OA, Bawazir A (2021) Congenital Diaphragmatic Hernia in Neonates: Open Versus Thoracoscopic Repair. Afr J Paediatr Surg 18: 18-23. https://doi.org/10.4103/ajps.AJPS_76_20 |
| [18] | 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: 1369-1375. https://doi.org/10.1016/j.jpedsurg.2005.05.036 |
| [19] | Nagata K, Usui N, Terui K, Takayasu H, Goishi K, Hayakawa M, Tazuke Y, Yokoi A, Okuyama H, Taguchi T (2015). Risk factors for the recurrence of the congenital diaphragmatic hernia-report from the long-term follow-up study of Japanese CDH study group. Eur J Pediatr Surg 25: 9-14. https://doi.org/10.1055/s-0034-1395486 |
| [20] | Putnam LR, Gupta V, Tsao K, Davis CF, Lally PA, Lally KP, Harting MT, Congenital Diaphragmatic Hernia Study Group (2017) Factors associated with early recurrence after congenital diaphragmatic hernia repair. J Pediatr Surg 52: 928-932. https://doi.org/10.1016/j.jpedsurg.2017.03.011 |
| [21] | Hattori K, Takamizawa S, Miyake Y, Hatata T, Yoshizawa K, Furukawa T, Kondo Y (2018) Preoperative sonographic evaluation of the defect size and the diaphragm rim in congenital diaphragmatic hernia - preliminary experience. Pediatr Radiol 48: 1550-1555. https://doi.org/10.1007/s00247-018-4184-y |
| [22] | Hosokawa T, Yamada Y, Takahashi H, Tanami Y, Sato Y, Ishimaru T, Tanaka Y, Kawashima H, Hosokawa M, Oguma E (2019) Postnatal ultrasound to determine the surgical strategy for congenital diaphragmatic hernia. J Ultrasound Med 38: 2347-2358. https://doi.org/10.1002/jum.14929 |
| [23] | Obata S, Souzaki R, Fukuta A, Esumi G, Nagata K, Matsuura T, Ieiri S, Taguchi T (2020) Which is the better approach for late-presenting congenital diaphragmatic hernia: laparoscopic or thoracoscopic? a single institution's experience of more than 10 years. J Laparoendosc Adv Surg Tech A 30: 1029-1035. https://doi.org/10.1089/lap.2019.0162 |
| [24] | 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: 304-306. https://doi.org/10.1089/lap.2011.0304 |
APA Style
Ping Zhao, Wei Zuo, Wei Gao, Xiang Liu. (2022). Conversion to Open Repair During Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Risk Factors and Countermeasures. American Journal of Pediatrics, 8(3), 152-157. https://doi.org/10.11648/j.ajp.20220803.11
ACS Style
Ping Zhao; Wei Zuo; Wei Gao; Xiang Liu. Conversion to Open Repair During Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Risk Factors and Countermeasures. Am. J. Pediatr. 2022, 8(3), 152-157. doi: 10.11648/j.ajp.20220803.11
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Download@article{10.11648/j.ajp.20220803.11,
author = {Ping Zhao and Wei Zuo and Wei Gao and Xiang Liu},
title = {Conversion to Open Repair During Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Risk Factors and Countermeasures},
journal = {American Journal of Pediatrics},
volume = {8},
number = {3},
pages = {152-157},
doi = {10.11648/j.ajp.20220803.11},
url = {https://doi.org/10.11648/j.ajp.20220803.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220803.11},
abstract = {There are currently no general guidelines on the selection criteria for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) in neonates, and some patients who are not suitable for the thoracoscopic approach have to be converted to open repair (OR) after undergoing initial thoracoscopy. The aim of this study was to evaluate factors associated with conversion to OR during TR of neonatal cases of CDH and to explore countermeasures against conversion. Medical records of neonates who underwent thoracoscopy for Bochdalek-type CDH at a tertiary center from January 2013 to July 2019 were retrospectively reviewed. We defined two groups: the T group included neonates undergoing complete TR and the TO group included neonates requiring conversion to OR during TR. Thoracoscopy was performed in 58 neonates, with 48 in T group and 10 in TO group. The conversion rate was 17.2%. The proportion of patients with diaphragmatic defect size greater than 6 cm x 5 cm was significantly higher in the TO group than in the T group (30% vs. 2.08%; p = 0.014). The rate of patch use was significantly higher in the TO group compared to the T group (30% vs. 4.17%; p = 0.032). There was no statistically significant difference between the two groups in terms of stomach herniation or liver herniation. The postoperative recurrence rate was 17.78% in the T group and 0% in the TO group (p = 0.39). Defect size greater than 6 cm x 5 cm and patch use were associated with higher conversion rate, while stomach herniation and liver herniation were not. Patients who require conversion but are not actually converted to open repair may have a higher risk of postoperative recurrence.},
year = {2022}
}
TY - JOUR T1 - Conversion to Open Repair During Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Risk Factors and Countermeasures AU - Ping Zhao AU - Wei Zuo AU - Wei Gao AU - Xiang Liu Y1 - 2022/07/20 PY - 2022 N1 - https://doi.org/10.11648/j.ajp.20220803.11 DO - 10.11648/j.ajp.20220803.11 T2 - American Journal of Pediatrics JF - American Journal of Pediatrics JO - American Journal of Pediatrics SP - 152 EP - 157 PB - Science Publishing Group SN - 2472-0909 UR - https://doi.org/10.11648/j.ajp.20220803.11 AB - There are currently no general guidelines on the selection criteria for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) in neonates, and some patients who are not suitable for the thoracoscopic approach have to be converted to open repair (OR) after undergoing initial thoracoscopy. The aim of this study was to evaluate factors associated with conversion to OR during TR of neonatal cases of CDH and to explore countermeasures against conversion. Medical records of neonates who underwent thoracoscopy for Bochdalek-type CDH at a tertiary center from January 2013 to July 2019 were retrospectively reviewed. We defined two groups: the T group included neonates undergoing complete TR and the TO group included neonates requiring conversion to OR during TR. Thoracoscopy was performed in 58 neonates, with 48 in T group and 10 in TO group. The conversion rate was 17.2%. The proportion of patients with diaphragmatic defect size greater than 6 cm x 5 cm was significantly higher in the TO group than in the T group (30% vs. 2.08%; p = 0.014). The rate of patch use was significantly higher in the TO group compared to the T group (30% vs. 4.17%; p = 0.032). There was no statistically significant difference between the two groups in terms of stomach herniation or liver herniation. The postoperative recurrence rate was 17.78% in the T group and 0% in the TO group (p = 0.39). Defect size greater than 6 cm x 5 cm and patch use were associated with higher conversion rate, while stomach herniation and liver herniation were not. Patients who require conversion but are not actually converted to open repair may have a higher risk of postoperative recurrence. VL - 8 IS - 3 ER -
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