Safe thoracoscopic repair of recurrent congenital diaphragmatic hernia after initial open abdominal repair

• Published in: Surgery today (Tokyo, Japan) Vol. 54; no. 6; pp. 534 - 539
• Main Authors: Gohda, Yousuke, Yokota, Kazuki, Uchida, Hiroo, Shirota, Chiyoe, Tainaka, Takahisa, Sumida, Wataru, Makita, Satoshi, Takimoto, Aitaro, Takada, Shunya, Nakagawa, Yoichi, Maeda, Takuya, Guo, Yaohui, Hinoki, Akinari
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.06.2024
• Subjects: Abdomen - surgery; Female; Hernias, Diaphragmatic, Congenital - surgery; Herniorrhaphy - methods; Humans; Infant, Newborn; Intraoperative Complications - etiology; Male; Medicine; Medicine & Public Health; Operative Time; Original Article; Postoperative Complications - etiology; Recurrence; Reoperation; Safety; Surgery; Surgical Oncology; Thoracoscopy - methods; Treatment Outcome; Recurrence; Congenital diaphragmatic hernia; Thoracoscopic surgery
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-023-02757-y

Purpose The optimal surgical approach for recurrent congenital diaphragmatic hernia (CDH) remains controversial. We compared the surgical outcomes of a thoracoscopic approach versus an open abdominal approach for recurrent CDH after initial abdominal open repair. Method The subjects of this comparative study were patients who underwent open abdominal or thoracoscopic surgery for recurrent CDH following an initial open abdominal repair. Results Among 166 patients with Bochdalek-type CDH, 15 underwent reoperation for recurrent CDH following an open abdominal repair. Seven patients underwent open abdominal surgery (group O) and eight underwent thoracoscopic surgery (group T). The operative duration was similar for the two groups, with less blood loss (17.2 ml/kg vs. 1 ml/kg, P  = 0.001) and fewer intraoperative complications in the T group ( n  = 6 vs. n  = 0 cases, P  = 0.001). There was no significant difference in the number of postoperative complications ( n  = 1 vs. n  = 1, P  = 1.0) or in the number of patients with a second CDH recurrence ( n  = 2 vs. n  = 1, P  = 0.569) between the two groups. Conclusion Thoracoscopic surgery is preferable to the open surgical approach for recurrent CDH following an initial abdominal open repair.