Standardized Indications to Assist in the Safe Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates.

BACKGROUND

To analyze the early outcome of thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH) with standardized indications.

METHODS

Clinical data of 14 neonates with CDH who underwent TR from September 2013 to August 2014 were retrospectively analyzed.

SELECTION CRITERIA: weight beyond 2.0 kg; liver in the abdomen; no intestinal obstruction; no severe cardiopulmonary anomalies; not required high-frequency oscillatory ventilation or extracorporeal membrane oxygenation. Timing of surgery: mean arterial blood pressure normal for gestational age; preductal saturation levels of 85%-95% on fractional inspired oxygen below 50%; lactate below 3 mmol/L; urine output more than 2 mL/kg/h. Fourteen cases in the historical control group who underwent open repair (OR) with the same physiological status were reviewed for comparison.

RESULTS

Demographic features were similar between the TR group and OR group. The TR group had a higher intraoperative mean PaCO2 (48 ± 8 mmHg versus 39 ± 6 mmHg, P = .0024) and mean arterial pH (7.30 ± 0.06 versus 7.39 ± 0.06, P = .0005), but no differences in lactate (0.93 ± 0.16 mmol/L versus 0.98 ± 0.14 mmol/L, P = .3869). Longer operation time was found in the TR group (116 ± 27 minutes versus 74 ± 25 minutes, P = .0002). No recurrence was observed in groups within the first year of life follow-up.

CONCLUSIONS

With selection criteria and timing, TR of CDH in neonates can be performed safely and successfully.