Advances in clinical and experimental medicine : official organ Wroclaw Medical University · 2020
The application of the percutaneous suturing technique in thoracoscopic repair of congenital diaphragmatic hernia.
СтатьяНазвание и аннотация: Перевод в очереди
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Bogusz Bartosz, Mol Adam, Zgraj Oskar, Górecki Wojciech
Аннотация
BACKGROUND: Thoracoscopic surgery of congenital diaphragmatic hernia (CDH) is connected with a higher incidence of recurrence than open repair is. This is usually caused by the dehiscence of sutures in the lateral part of the defect. This area is characterized by increased tension on proximate tissues and difficult thoracoscopic suturing. For more effective repair, the authors adopted a variant of percutaneous internal ring suturing (PIRS) technique.
OBJECTIVES: To present and evaluate the efficacy of the PIRS technique for the repair of CDH.
MATERIAL AND METHODS: The study is based on retrospective analysis of the medical data of patients with CDH treated in the Department of Pediatric Surgery of the Jagiellonian University Medical College (Kraków, Poland) from January 2013 to July 2019. The PIRS technique was applied when thoracoscopic repair under acceptable tension appeared impossible.
RESULTS: Fifty-one patients were identified. Of these, 11 children died before surgery and 1 after, leaving 39 (76%) who were operated on and survived. Thoracoscopy was used in 27 cases (69%), with 3 conversions. The recurrence rate in patients who underwent thoracoscopic closure of the defect with intermittent sutures was 27% (3 out of 11 children), while in the group that underwent thoracoscopic repair with the additional use of percutaneous suturing, the recurrence rate was 6.25% (1 out of 16 patients). The follow-up periods ranged from 4 months to 6 years.
CONCLUSIONS: The applied PIRS technique permits safe and effective closure of intermediate-size diaphragmatic defects under acceptable tension. The method is feasible and can be listed among countermeasures against recurrence.
OBJECTIVES: To present and evaluate the efficacy of the PIRS technique for the repair of CDH.
MATERIAL AND METHODS: The study is based on retrospective analysis of the medical data of patients with CDH treated in the Department of Pediatric Surgery of the Jagiellonian University Medical College (Kraków, Poland) from January 2013 to July 2019. The PIRS technique was applied when thoracoscopic repair under acceptable tension appeared impossible.
RESULTS: Fifty-one patients were identified. Of these, 11 children died before surgery and 1 after, leaving 39 (76%) who were operated on and survived. Thoracoscopy was used in 27 cases (69%), with 3 conversions. The recurrence rate in patients who underwent thoracoscopic closure of the defect with intermittent sutures was 27% (3 out of 11 children), while in the group that underwent thoracoscopic repair with the additional use of percutaneous suturing, the recurrence rate was 6.25% (1 out of 16 patients). The follow-up periods ranged from 4 months to 6 years.
CONCLUSIONS: The applied PIRS technique permits safe and effective closure of intermediate-size diaphragmatic defects under acceptable tension. The method is feasible and can be listed among countermeasures against recurrence.