Simple and safe thoracoscopic repair of neonatal congenital diaphragmatic hernia by a new modified knot-tying technique.

PURPOSE: Clinical outcomes in infants with congenital diaphragmatic hernia (CDH) may be improved by thoracoscopic repair. However, the limited domain and large diaphragmatic defects in neonates are obstacles. Here, we present a special knot-tying technique that facilitates a safe and efficient thoracoscopic CDH repair in neonates.

METHODS

An extracorporeal slip knot is assembled after a stitch through the diaphragmatic edge, one end of the string is pulled, and the knot slides to reach the diaphragm easily without a knot-pusher. Then two more uncomplicated single-loop knots are performed to secure its tightness intrathoracically. Twenty-six consecutive neonates with CDH were treated by this technique. The technical advantages and clinical outcomes were evaluated.

RESULTS

All 26 patients were treated successfully, including 6 patch-repairs and 1 case with associated extra-lobar pulmonary sequestration. The mean operative times with and without patch-repair were 149 ± 26 min and 95 ± 25 min, respectively. All cases were completed without conversion. No recurrence was observed at a median follow-up of 13.7 months (range 5.8-29.8 months).

CONCLUSIONS

This special knot-tying technique is easy to learn and does not require any additional devices. It is a simple and accessible technique that can facilitate thoracoscopic repair of neonatal CDH within the limited space and with patch-repair.