JTCVS techniques · 2025
Diaphragmatic paralysis after cardiac surgery in children: Long-term results of a simple thoracoscopic diaphragmatic plication technique.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Carlos de Agustín-Asensio Juan, Peláez-Mata David, Monje-Fuente Sara, Vázquez-González Pilar, Benito-Anguita Marta
Аннотация
OBJECTIVES: Thoracoscopic treatment of symptomatic diaphragmatic paralysis can be challenging, especially after surgery. We studied the efficacy and safety of a minimally invasive diaphragmatic plication technique.
METHODS: A retrospective review was conducted on children who underwent thoracoscopic diaphragmatic repair after cardiac surgery between 2011 and 2020. The technique used a 3-mm camera, a 3-mm trocar, and an 18-gauge epidural needle to access the pleural space. The needle was threaded from posterior to anterior through the diaphragm to place nonabsorbable sutures, creating tension.
RESULTS: Forty-five patients (28 male, 17 female) were reviewed, with a median age of 39.5 ± 28 days (range, 8 days to 13 years). The median surgical time was 65.97 ± 12.6 minutes. No organ injuries or conversions to thoracotomy occurred. A chest drain was placed in 18 patients, removed after an average of 1.8 ± 1.2 days. Three patients experienced postoperative complications (severe pneumothorax or persistent pleural effusion), requiring additional chest tubes for 3.6 ± 2 days. All patients were extubated after 2.13 ± 2.3 days. After a follow-up of 6 months to 10 years, 4 recurrences (8.8%) were resolved with re-thoracoscopy and 1 thoracotomy.
CONCLUSIONS: The needle thoracoscopic diaphragmatic plication technique is simple and associated with low recurrence and complication rates. It is considered the technique of choice for newborns and infants, with favorable long-term results.
METHODS: A retrospective review was conducted on children who underwent thoracoscopic diaphragmatic repair after cardiac surgery between 2011 and 2020. The technique used a 3-mm camera, a 3-mm trocar, and an 18-gauge epidural needle to access the pleural space. The needle was threaded from posterior to anterior through the diaphragm to place nonabsorbable sutures, creating tension.
RESULTS: Forty-five patients (28 male, 17 female) were reviewed, with a median age of 39.5 ± 28 days (range, 8 days to 13 years). The median surgical time was 65.97 ± 12.6 minutes. No organ injuries or conversions to thoracotomy occurred. A chest drain was placed in 18 patients, removed after an average of 1.8 ± 1.2 days. Three patients experienced postoperative complications (severe pneumothorax or persistent pleural effusion), requiring additional chest tubes for 3.6 ± 2 days. All patients were extubated after 2.13 ± 2.3 days. After a follow-up of 6 months to 10 years, 4 recurrences (8.8%) were resolved with re-thoracoscopy and 1 thoracotomy.
CONCLUSIONS: The needle thoracoscopic diaphragmatic plication technique is simple and associated with low recurrence and complication rates. It is considered the technique of choice for newborns and infants, with favorable long-term results.