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Jank M, Boettcher M, Keijzer R. Surgical management of the diaphragmatic defect in congenital diaphragmatic hernia: a contemporary review. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000747. [PMID: 39183804 PMCID: PMC11340723 DOI: 10.1136/wjps-2023-000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
Worldwide, 150 children are born each day with congenital diaphragmatic hernia (CDH), a diaphragmatic defect with concomitant abnormal lung development. Patients with CDH with large defects are particularly challenging to treat, have the highest mortality, and are at significant risk of long-term complications. Advances in prenatal and neonatal treatments have improved survival in high-risk patients with CDH, but surgical treatment of large defects lacks standardization. Open repair by an abdominal approach has long been considered the traditional procedure, but the type of defect repair (patch or muscle flap) and patch material (non-absorbable, synthetic or absorbable, biological) remain subjects of debate. Increased experience and improved techniques in minimally invasive surgery (MIS) have expanded selection criteria for thoracoscopic defect repair in cardiopulmonary stable patients with small defects. However, the application of MIS to repair large defects remains controversial due to increased recurrence rates and unknown long-term effects of perioperative hypercapnia and acidosis resulting from capnothorax and reduced ventilation. Current recommendations on the surgical management rely on cohort studies of varying patient numbers and data on the long-term outcomes are sparse. Here, we discuss surgical approaches for diaphragmatic defect repair highlighting advancements, and knowledge gaps in surgical techniques (open surgery and MIS), patch materials and muscle flaps for large defects, as well as procedural adjuncts and management of CDH variants.
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Affiliation(s)
- Marietta Jank
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, Rady Faculty of Heath Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Surgery, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, Rady Faculty of Heath Sciences, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Saxena AK, Hayward RK. Patches in Congenital Diaphragmatic Hernia: Systematic Review. Ann Surg 2024; 280:229-234. [PMID: 38450531 DOI: 10.1097/sla.0000000000006256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This systematic review aims to evaluate current choices in practice and outcomes of biomaterials used in patch repair of congenital diaphragmatic hernia (CDH). BACKGROUND Multiple biomaterials, both novel and combinations of pre-existing materials are employed in patch repair of large size CDHs. METHODS A literature search was performed across Embase, Medline, Scopus, and Web of Science. Publications that explicitly reported patch repair, material used, and recurrences following CDH repair were selected. RESULTS Sixty-three papers were included, presenting data on 4595 patients, of which 1803 (39.2%) were managed using 19 types of patches. Goretex® (GTX) (n=1106) was the most frequently employed patch followed by Dualmesh® (n=267), Surgisis® (n=156), Marlex®/GTX® (n=56), Tutoplast dura® (n=40), Dacron® (n=34), Dacron®/GTX® (n=32), Permacol® (n=24), Teflon® (n=24), Surgisis®/GTX® (n=15), Sauvage® Filamentous Fabric (n=13), Marlex® (n=9), Alloderm® (n=8), Silastic® (n=4), Collagen coated Vicryl® mesh (CCVM) (n=1), Mersilene® (n=1), and MatriStem® (n=1) Biomaterials were further subgrouped as: synthetic nonresorbable (SNOR) (n=1458), natural resorbable (NR) (n=241), combined natural and synthetic nonresorbable (NSNOR) (n=103), and combined natural and synthetic resorbable (NSR) (n=1). The overall recurrence rate for patch repair was 16.6% (n=299). For patch types with n>20, recurrence rate was lowest in GTX/Marlex (3.6%), followed by Teflon (4.2%), Dacron (5.6%), Dualmesh (12.4%), GTX (14.8%), Permacol (16.0%), Tutoplast Dura (17.5%), SIS/GTX (26.7%), SIS (34.6%), and Dacron/GTX (37.5%).When analyzed by biomaterial groups, recurrence was highest in NSR (100%), followed by NR (31.5%), NSNOR (17.5%), and SNOR the least (14.0%). CONCLUSION In this cohort, over one-third of CDH were closed using patches. To date, 19 patch types/variations have been employed for CDH closure. GTX is the most popular, employed in over 60% of patients; however, excluding smaller cohorts (n<20), GTX/Marlex is associated with the lowest recurrence rate (3.6%). SNOR was the material type least associated with recurrence, while NSR experienced recurrence in every instance.
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Affiliation(s)
- Amulya K Saxena
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
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Shibuya S, Paraboschi I, Giuliani S, Tsukui T, Matei A, Olivos M, Inoue M, Clarke SA, Yamataka A, Zani A, Eaton S, De Coppi P. Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair. Pediatr Surg Int 2024; 40:182. [PMID: 38980431 PMCID: PMC11233350 DOI: 10.1007/s00383-024-05760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR. METHODS A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588). RESULTS Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02]. CONCLUSIONS TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease.
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Affiliation(s)
- Soichi Shibuya
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research & Teaching Department, Zayed Centre for Research Into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1E, UK.
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo City, Tokyo, 113-8431, Japan.
| | - Irene Paraboschi
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
| | - Stefano Giuliani
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Takafumi Tsukui
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo City, Tokyo, 113-8431, Japan
| | - Andreea Matei
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Mikihiro Inoue
- Department of Pediatric Surgery, Fujita Health University, Aichi, Japan
| | - Simon A Clarke
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo City, Tokyo, 113-8431, Japan
| | - Augusto Zani
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Simon Eaton
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research & Teaching Department, Zayed Centre for Research Into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1E, UK
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research & Teaching Department, Zayed Centre for Research Into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1E, UK.
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
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Shah NR, Criss CN, Burgi K, Matusko N, Geiger JD, Perrone EE, Mychaliska GB, Ralls MW. Thoracoscopic Patch Repair of Congenital Diaphragmatic Hernia: Can Smaller Incisions Treat Larger Defects? J Pediatr Surg 2024; 59:1083-1088. [PMID: 37867043 DOI: 10.1016/j.jpedsurg.2023.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Thoracoscopic CDH repair is increasingly performed for Type A and small Type B defects that are amenable to primary repair. However, the thoracoscopic approach is controversial for larger defects necessitating a patch due to technical complexity, intraoperative acidosis, and recurrence risk. We aim to compare clinical outcomes between thoracoscopic and open patch repair of Type B/C defects, using a standardized technique. METHODS This is a single-center retrospective review of thoracoscopic and open CDH patch repairs January 2017-December 2021. We excluded primary repairs, Type D hernias, repairs on ECMO, recurrent repairs. Various preoperative, intraoperative, and postoperative variables were compared. Primary outcome was recurrence rate. Secondary outcomes included intraoperative pH and pCO2, operative time, and complication rates. RESULTS Twenty-nine patients met inclusion criteria (open = 13, thoracoscopic = 16). The open cohort had lower o/e total fetal lung volume (29 vs 41.2%, p = 0.042), higher preoperative peak inspiratory pressures (24 vs 20 cm H2O, p = 0.007), were more frequently Type C defects (92.3 vs 31%, p = 0.002) and had liver "up" in left-sided hernias (46 vs 0%, p < 0.0001). Intraoperatively, median lowest pH and highest pCO2 did not differ; neither did overall median pH or pCO2. Operative times were similar (153 vs 194 min, p = 0.113). No difference in recurrence rates was identified, however postoperative complications were higher in the open group. There were no mortalities. CONCLUSIONS Although we demonstrate higher disease severity of patients undergoing open repair, thoracoscopic patch repair for Type B/C defects is safe and effective in patients with favorable physiologic status, alleviating concerns for intraoperative acidosis, operative length, and risk of recurrence. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Nikhil R Shah
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA.
| | - Cory N Criss
- Nationwide Children's Hospital, Department of Surgery, Section of Pediatric Surgery, 700 Childrens Dr., Columbus, OH 43205, USA
| | - Keerthi Burgi
- University of Michigan School of Medicine, 1301 Catherine St., Ann Arbor, MI 48109-4211, USA
| | - Niki Matusko
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA
| | - James D Geiger
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA
| | - Erin E Perrone
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA
| | - George B Mychaliska
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA
| | - Matthew W Ralls
- University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, USA
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da Costa KM, Stratulat I, Saxena AK. Reasons for conversions in thoracoscopic repairs of neonatal congenital diaphragmatic hernias: a systematic review. Surg Endosc 2024; 38:2405-2410. [PMID: 38619557 DOI: 10.1007/s00464-024-10831-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE This systematic review focused on reasons for conversions in neonates undergoing thoracoscopic congenital diaphragmatic hernia (CDH) repair. METHODS Systematic search of Medline/Pubmed and Embase was performed for English, Spanish and Portuguese reports, according to PRISMA guidelines. RESULTS Of the 153 articles identified (2003-2023), 28 met the inclusion criteria and offered 698 neonates for analysis. Mean birth weight and gestational age were 3109 g and 38.3 weeks, respectively, and neonates were operated at a mean age of 6.12 days. There were 278 males (61.50%; 278/452) and 174 females (38.50%; 174/452). The reasons for the 137 conversions (19.63%) were: (a) defect size (n = 22), (b) need for patch (n = 21); (c) difficulty in reducing organs (n = 14), (d) ventilation issues (n = 10), (e) bleeding, organ injury, cardiovascular instability (n = 3 each), (f) bowel ischemia and defect position (n = 2 each), hepatopulmonary fusion (n = 1), and (g) reason was not specified for n = 56 neonates (40.8%). The repair was primary in 322 neonates (63.1%; 322/510) and patch was used in 188 neonates (36.86%; 188/510). There were 80 recurrences (12.16%; 80/658) and 14 deaths (2.48%; 14/565). Mean LOS and follow-up were 20.17 days and 19.28 months, respectively. CONCLUSIONS Neonatal thoracoscopic repair for CDH is associated with conversion in 20% of cases. Based on available data, defect size and patch repairs have been identified as the predominant reasons, followed by technical difficulties to reduce the herniated organs and ventilation related issues. However, data specifically relating to conversion is poorly documented in a high number of reports (40%). Accurate data reporting in future will be important to better estimate and quantify reasons for conversions in neonatal thoracoscopy for CDH.
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Affiliation(s)
- Karina Miura da Costa
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
- Department of Health Sciences, Cesumar University (Unicesumar), Maringá, Paraná, Brazil
| | - Iulia Stratulat
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
| | - Amulya Kumar Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.
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6
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Lian TCY, Fung ACH, Wong KKY. Open Versus Thoracoscopic Repair of Congenital Diaphragmatic Hernia: A 19-Year Review in a Tertiary Referral Centre in Hong Kong. J Pediatr Surg 2024; 59:583-586. [PMID: 38160186 DOI: 10.1016/j.jpedsurg.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a developmental defect that causes herniation of abdominal organs into the thoracic cavity with significant morbidity. Thoracoscopic repair of CDH is an increasingly prevalent yet controversial surgical technique, with limited long-term outcome data in the Asian region. The aim of this study was to compare open laparotomy versus thoracoscopic repair of CDH in paediatric patients in a major tertiary referral centre in Asia. METHODS We performed a retrospective analysis of neonatal patients who had open laparotomy or thoracoscopic repair for CDH in our institution between July 2002 and November 2021. Demographic data, perioperative parameters, recurrence rates and surgical complications were analysed. RESULTS 64 patients were identified, with 54 left sided CDH cases. 33 patients had a prenatal diagnosis and 35 patients received minimally invasive surgical repair. There was no significant difference between open and minimally invasive repair in recurrence rate (13 % vs 17 %, P = 0.713), time to recurrence (184 ± 449 days vs 81 ± 383 days, P = 0.502), or median length of ICU stay (11 ± 14 days vs 13 ± 15 days, P = 0.343), respectively. Gastrointestinal complications occurred in 7 % of neonates in the open group and none in the thoracoscopic group. Median follow-up time was 9.5 years. CONCLUSIONS This study is a large congenital diaphragmatic hernia series in Asia, with long term follow-up demonstrating no significant difference in recurrence rate, time to recurrence or median length of ICU stay between open and minimally invasive repair, suggesting thoracoscopic approach is a non-inferior surgical option with avoidance of gastrointestinal complications compared to open repair. LEVEL OF EVIDENCE: 3 TYPE OF STUDY Retrospective Cohort Study.
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Affiliation(s)
- Tony Chao Yen Lian
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2050, Australia
| | - Adrian Chi Heng Fung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China.
| | - Kenneth Kak Yuen Wong
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China
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Scuglia M, Frazão LP, Miranda A, Martins A, Barbosa-Sequeira J, Coimbra D, Longatto-Filho A, Reis RL, Nogueira-Silva C, Neves NM, Correia-Pinto J. Diaphragmatic hernia repair porcine model to compare the performance of biodegradable membranes against Gore-Tex ®. Pediatr Surg Int 2023; 40:7. [PMID: 37999778 PMCID: PMC10673990 DOI: 10.1007/s00383-023-05584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Patch repair of congenital diaphragmatic hernia (CDH) using Gore-Tex® is associated with infection, adhesions, hernia recurrence, long-term musculoskeletal sequels and poor tissue regeneration. To overcome these limitations, the performance of two novel biodegradable membranes was tested to repair CDH in a growing pig model. METHODS Twelve male pigs were randomly assigned to 3 different groups of 4 animals each, determined by the type of patch used during thoracoscopic diaphragmatic hernia repair (Gore-Tex®, polycaprolactone electrospun membrane-PCLem, and decellularized human chorion membrane-dHCM). After 7 weeks, all animals were euthanized, followed by necropsy for diaphragmatic evaluation and histological analysis. RESULTS Thoracoscopic defect creation and diaphragmatic repair were performed without any technical difficulty in all groups. However, hernia recurrence rate was 0% in Gore-Tex®, 50% in PCLem and 100% in dHCM groups. At euthanasia, Gore-Tex® patches appeared virtually unchanged and covered with a fibrotic capsule, while PCLem and dHCM patches were replaced by either floppy connective tissue or vascularized and floppy regenerated membranous tissue, respectively. CONCLUSION Gore-Tex® was associated with a higher survival rate and lower recurrence. Nevertheless, the proposed biodegradable membranes were associated with better tissue integration when compared with Gore-Tex®.
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Affiliation(s)
- Marianna Scuglia
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Laura P Frazão
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group, I3B's - Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal
| | - Alice Miranda
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Albino Martins
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group, I3B's - Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal
| | - Joana Barbosa-Sequeira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Pediatric Surgery, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diana Coimbra
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Rui L Reis
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group, I3B's - Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal
| | - Cristina Nogueira-Silva
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Obstetrics and Gynecology, Hospital de Braga, Braga, Portugal
| | - Nuno M Neves
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
- 3B's Research Group, I3B's - Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal.
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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A predictive scoring system for small diaphragmatic defects in infants with congenital diaphragmatic hernia. Pediatr Surg Int 2022; 39:4. [PMID: 36441244 DOI: 10.1007/s00383-022-05287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a predictive score for small diaphragmatic defects in infants with congenital diaphragmatic hernia (CDH) for determining thoracoscopic surgery indication. METHODS The Japanese CDH Study Group cohort was randomly divided into derivation (n = 397) and validation (n = 396) datasets. Using logistic regression, a prediction model and weighted scoring system for small diaphragmatic defects were created from derivation dataset and validated with validation dataset. RESULTS Six weighted variables were selected: no hydramnios, 1 point; 1 min Apgar score of 5-10, 1 point; apex type of the lung (left lung is detected radiographically in apex area), 1 point; oxygenation index < 8, 1 point; abdominal nasogastric tube (tip of the nasogastric tube is detected radiographically in the abdominal area), 2 points; no right-to-left flow of ductus arteriosus, 1 point. In validation dataset, rates of small diaphragmatic defects for Possible (0-3 points), Probable (4-5 points), and Definite (6-7 points) groups were 36%, 81%, and 94%, respectively (p < 0.001). Additionally, sensitivity, specificity, positive predictive value, and C statistics were 0.78, 0.79, 0.88, 0.76, and 0.45, 0.94, 0.94, 0.70 for Probable and Definite groups, respectively. CONCLUSION Our scoring system effectively predicted small diaphragmatic defects in infants with CDH.
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Deguchi K, Watanabe M, Yoneyama T, Masahata K, Nomura M, Saka R, Yamanaka H, Kamiyama M, Ueno T, Tazuke Y, Okuyama H. Tension-free thoracoscopic repair of congenital diaphragmatic hernia combined with a percutaneous extracorporeal closure technique: how to do it. Surg Today 2022; 53:640-646. [PMID: 36333435 DOI: 10.1007/s00595-022-02609-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) is associated with a higher recurrence rate than the conventional open method. We evaluated the effectiveness of our strategy for quality improvement, named "tension-free TR of CDH". METHODS The subjects of this retrospective analysis were 11 consecutive patients with CDH who underwent TR at our hospital between 2017 and 2021. Tension-free TR of CDH included the proactive use of an oversized patch for dome-shaped reconstruction and gapless suturing. We developed a percutaneous extracorporeal closure technique for secure suturing using a commercially available needle. RESULTS Patch repair was performed in 8 (73%) patients and none required conversion to open surgery because of technical difficulties. Recurrence developed in one patient (9%), who underwent successful reoperation via TR. All patients had an uneventful postoperative course. CONCLUSION Tension-free TR combined with extracorporeal closure could reduce the difficulty of suturing and the risk of recurrence of CDH.
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Shu B, Feng X, Martynov I, Lacher M, Mayer S. Pediatric Minimally Invasive Surgery-A Bibliometric Study on 30 Years of Research Activity. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081264. [PMID: 36010154 PMCID: PMC9406539 DOI: 10.3390/children9081264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022]
Abstract
Background: Pediatric minimally invasive surgery (MIS) is a standard technique worldwide. We aimed to analyze the research activity in this field. Methods: Articles on pediatric MIS (1991−2020) were analyzed from the Web of Science™ for the total number of publications, citations, journals, and impact factors (IF). Of these, the 50 most cited publications were evaluated in detail and classified according to the level of evidence (i.e., study design) and topic (i.e., surgical procedure). Results: In total, 4464 publications and 53,111 citations from 684 journals on pediatric MIS were identified. The 50 most cited papers were published from 32 institutions in the USA/Canada (n = 28), Europe (n = 19), and Asia (n = 3) in 12 journals. Four authors (USA/Europe) contributed to 26% of the 50 most cited papers as first/senior author. Hot topics were laparoscopic pyeloplasty (n = 9), inguinal hernia repair (n = 7), appendectomy, and pyloromyotomy (n = 4 each). The majority of publications were retrospective studies (n = 33) and case reports (n = 6) (IF 5.2 ± 3.2; impact index 16.5 ± 6.4; citations 125 ± 39.4). They were cited as often as articles with high evidence levels (meta-analyses, n = 2; randomized controlled trials, n = 7; prospective studies, n = 2) (IF 12.9 ± 22.5; impact index 14.0 ± 6.5; citations 125 ± 34.7; p > 0.05). Conclusions: Publications on laparoscopic pyeloplasty, inguinal hernia repair, appendectomy, and pyloromyotomy are cited most often in pediatric MIS. However, the relevant number of studies with strong evidence for the advantages of MIS in pediatric surgery is missing.
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11
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Hendrikx D, Costerus SA, Zahn K, Perez-Ortiz A, Dorado AC, Van Huffel S, de Graaff J, Wijnen R, Wessel L, Tibboel D, Naulaers G. Neurocardiovascular coupling in congenital diaphragmatic hernia patients undergoing different types of surgical treatment. Eur J Anaesthesiol 2022; 39:662-672. [PMID: 34860716 PMCID: PMC9451916 DOI: 10.1097/eja.0000000000001642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effect of peri-operative management on the neonatal brain is largely unknown. Triggers for perioperative brain injury might be revealed by studying changes in neonatal physiology peri-operatively. OBJECTIVE To study neonatal pathophysiology and cerebral blood flow regulation peri-operatively using the neuro-cardiovascular graph. DESIGN Observational, prospective cohort study on perioperative neuromonitoring. Neonates were included between July 2018 and April 2020. SETTING Multicentre study in two high-volume tertiary university hospitals. PATIENTS Neonates with congenital diaphragmatic hernia were eligible if they received surgical treatment within the first 28 days of life. Exclusion criteria were major cardiac or chromosomal anomalies, or syndromes associated with altered cerebral perfusion or major neurodevelopmental impairment. The neonates were stratified into different groups by type of peri-operative management. INTERVENTION Each patient was monitored using near-infrared spectroscopy and EEG in addition to the routine peri-operative monitoring. Neurocardiovascular graphs were computed off-line. MAIN OUTCOME MEASURES The primary endpoint was the difference in neurocardiovascular graph connectivity in the groups over time. RESULTS Thirty-six patients were included. The intraoperative graph connectivity decreased in all patients operated upon in the operation room (OR) with sevoflurane-based anaesthesia ( P < 0.001) but remained stable in all patients operated upon in the neonatal intensive care unit (NICU) with midazolam-based anaesthesia. Thoracoscopic surgery in the OR was associated with the largest median connectivity reduction (0.33 to 0.12, P < 0.001) and a loss of baroreflex and neurovascular coupling. During open surgery in the OR, all regulation mechanisms remained intact. Open surgery in the NICU was associated with the highest neurovascular coupling values. CONCLUSION Neurocardiovascular graphs provided more insight into the effect of the peri-operative management on the pathophysiology of neonates undergoing surgery. The neonate's clinical condition as well as the surgical and the anaesthesiological approach affected the neonatal physiology and CBF regulation mechanisms at different levels. TRIAL REGISTRATION NL6972, URL: https://www.trialre-gister.nl/trial/6972 .
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12
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Michel AJ, Metzger U, Rice SA, Metzger R. Thoracoscopic Guided Pericostal Sutures as a Solid Fixation for Primary Closure of Congenital Diaphragmatic Hernias. CHILDREN 2022; 9:children9081116. [PMID: 35892619 PMCID: PMC9331833 DOI: 10.3390/children9081116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Purpose: To describe a minimally invasive technique with primary closure and strong suture connection that is feasible in cases of larger, most common type B defects of congenital diaphragmatic hernia (CDH). Background: The thoracoscopic approach (TA) is a favorable technique for the repair of CDH and is still evolving globally. A common issue is finding the optimal suture technique for secure closure in order to prevent recurrences. Whether a defect can be closed only by sutures or by using a patch depends on the size of CDH, the presence of a muscular rim along the inner thoracic surface and finally on the surgeon’s experience. From a geometrical point of view, the challenge is to transform the circular defect into a line, without tension, with a strong compound and preferably without additional material. To address this, we apply a setting of the sutures in a “T-shape” and a way to lead the sutures around the rib bones in order to increase stability. This method allows for the primary closure of CDHs and also applies to larger defects. Cases: We present seven newborns with posterolateral CDH on the left side. The defects were solely repaired by TA and by the suturing technique described in detail.
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Affiliation(s)
- Armin-Johannes Michel
- Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria; (U.M.); (R.M.)
- Correspondence:
| | - Ulrike Metzger
- Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria; (U.M.); (R.M.)
| | - Steven Alan Rice
- University Hospital for Children and Adolescents, Universitätsmedizin Rostock, 18057 Rostock, Germany;
| | - Roman Metzger
- Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria; (U.M.); (R.M.)
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13
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Boehm AK, Hillebrandt KH, Dziodzio T, Krenzien F, Neudecker J, Spuler S, Pratschke J, Sauer IM, Andreas MN. Tissue engineering for the diaphragm and its various therapeutic possibilities – A Systematic Review. ADVANCED THERAPEUTICS 2022. [DOI: 10.1002/adtp.202100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Agnes K Boehm
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
| | - Karl H Hillebrandt
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin Charitéplatz 1 Berlin 10117 Germany
| | - Tomasz Dziodzio
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin Charitéplatz 1 Berlin 10117 Germany
| | - Felix Krenzien
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin Charitéplatz 1 Berlin 10117 Germany
| | - Jens Neudecker
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
| | - Simone Spuler
- Muscle Research Unit Experimental and Clinical Research Center Charité Universitätsmedizin Berlin and Max‐Delbrück‐Centrum für Molekulare Medizin in der Helmholtz‐Gemeinschaft Lindenberger Weg 80 Berlin 13125 Germany
| | - Johann Pratschke
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin Cluster of Excellence Matters of Activity. Image Space Material funded by the Deutsche Forschungsgemeinschaft (DFG German Research Foundation) under Germany's Excellence Strategy Berlin EXC 2025 Germany
| | - Igor M Sauer
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin Cluster of Excellence Matters of Activity. Image Space Material funded by the Deutsche Forschungsgemeinschaft (DFG German Research Foundation) under Germany's Excellence Strategy Berlin EXC 2025 Germany
| | - Marco N Andreas
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Department of Surgery Augustenburger Platz 1 Berlin 13353 Germany
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14
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Liu R, Zheng Z, Tang C, Zhang K, Du Q, Gong Y, Zhu D, Xia X, Zhou W, Huang L, Liu Y, Jin Z. Thoracoscopic surgery for congenital diaphragmatic hernia in neonates: Should it be the first choice? Front Pediatr 2022; 10:1020062. [PMID: 36389344 PMCID: PMC9659751 DOI: 10.3389/fped.2022.1020062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/07/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) is an uncommon but potentially life-threatening surgical condition in neonates. Surgery can be performed by either open or thoracoscopic techniques. In this study, we compared the clinical efficacy, safety, and effectiveness of thoracoscopic and open CDH repair. METHODS A retrospective review of neonates with CDH who underwent operations at our hospital from 2013 to 2021 was performed. The various perioperative parameters were compared between neonates undergoing thoracoscopic and open surgery. RESULTS There were 50 neonates in this study (37 in the thoracoscopic group and 13 in the open group). Thoracoscopic surgery was associated with significantly shorter hospital stay (13.32 vs. 18.77 days, p < 0.001); shorter duration of postoperative mechanical ventilation (3.70 vs. 5.98 days, p < 0.001); early feeding (4.34 vs. 7.46 days, p < 0.001); and shorter time to reach optimal feeding (8.21 vs. 13.38 days, p < 0.001). There was one postoperative death in the open group and no death in the thoracoscopic group. The median follow-up time of the two groups was 23.8 months (20.5 months in open group and 25.0 months in thoracoscopic group). Thoracoscopic surgery was associated with lower recurrence rates, but the difference was not statistically significant (2.7% vs. 7.7%, p = 0.456). CONCLUSION Thoracoscopy CDH repair, a safe and effective surgical technique for neonates, has better cosmesis, faster postoperative recovery, and a lower recurrence rate than other procedures. It can be considered the first choice for CDH treatment for neonates among experienced surgeons.
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Affiliation(s)
- Rui Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Zebing Zheng
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Chengyan Tang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Kaizhi Zhang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Qing Du
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Yuan Gong
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Daiwei Zhu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Xingrong Xia
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Wankang Zhou
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Lu Huang
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Yuanmei Liu
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
| | - Zhu Jin
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Pediatric Surgery, Guizhou Children's Hospital, Zunyi, China
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15
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Fuentes S, Núñez-Alfonsel J, Pradillos-Serna JM, Grande-Moreillo C, Margarit-Mallol J, Valladares-Díez S, Ardela-Díaz E. Quality of Life in Pediatric Minimally Invasive Surgery. Cost-Utility Analysis of Laparoscopic Versus Open Appendectomy. J Laparoendosc Adv Surg Tech A 2021; 32:219-225. [PMID: 34534010 DOI: 10.1089/lap.2021.0495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Economic evaluation in health care is becoming increasingly important. Laparoscopic appendectomy (LAp) is one of the most frequent minimally invasive procedures in the pediatric population. The increased costs of this approach in any indication could be justified by proving its cost-utility in terms of health-related quality of life (HRQoL). We aim to perform a cost-utility analysis between open and LAp (open appendectomy [OAp] and LAp). Materials and Methods: We included the data of children operated for acute noncomplicated appendicitis, who agreed to answer a validated quality of life (QoL) questionnaire. Costs were calculated for each patient. We established a threshold for cost-effectiveness (λ) of 20,000 to 30,000€ per quality adjusted life year (QALY) according to previous research. Results: A total of 53 patients were included. Overall mean costs in the OAp were 758.98€ and in the LAp 1525.50€. The incremental cost-effectiveness ratio was 18,000€/QALY, under the threshold of cost-effectiveness, therefore favoring the laparoscopic approach as it improves HRQoL despite the costs. Conclusions: Economic evaluation studies in Pediatric Surgery are scarce and rarely measure outcomes in terms of QoL. This information is important in the decision-making process for institutions and health-care professionals. Our results encourage the use of laparoscopy in pediatric appendectomy to improve HRQoL in our patients.
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Affiliation(s)
- Sara Fuentes
- Pediatric Surgery Department, Mútua de Terrassa University Hospital, Terrassa, Barcelona, Spain
| | - Javier Núñez-Alfonsel
- Instituto de Validación de la Eficiencia Clínica (IVEC), Cátedra de Medicina Basada en la Eficiencia, Fundación de Investigación HM Hospitales, Madrid. Spain
| | | | - Carme Grande-Moreillo
- Pediatric Surgery Department, Mútua de Terrassa University Hospital, Terrassa, Barcelona, Spain
| | - Jaume Margarit-Mallol
- Pediatric Surgery Department, Mútua de Terrassa University Hospital, Terrassa, Barcelona, Spain
| | | | - Erick Ardela-Díaz
- Pediatric Surgery Departament, León University Hospital, León, Spain
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16
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Heiwegen K, de Blaauw I, Botden SMBI. A systematic review and meta-analysis of surgical morbidity of primary versus patch repaired congenital diaphragmatic hernia patients. Sci Rep 2021; 11:12661. [PMID: 34135386 PMCID: PMC8209041 DOI: 10.1038/s41598-021-91908-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Large studies comparing the surgical outcome of primary versus patch repair in congenital diaphragmatic hernia (CDH) patients are rare. This study aims to evaluate the incidence of surgical complications in both types of CDH repair. PubMed, EMBASE, Cochrane and Web of Science were searched for peer-reviewed articles. Studies on CDH between 1991 and August 2020 were systematically screened and meta-analyses were performed. Primary outcomes of this review were: haemorrhage, chylothorax, recurrences and small bowel obstruction (SBO). A total of 6436 abstracts were screened, after which 25 publications were included (2910 patients). Patch repaired patients have a 2.8 times higher risk on developing a recurrence (20 studies) and a 2.5 times higher risk on developing a chylothorax (five studies). Moreover, they have a two times higher risk on developing a SBO. No studies could be included that evaluated the incidence of surgical haemorrhage between these patients. Although the quality of the studies was relatively low, patch repaired patients have a higher risk on developing a recurrence, chylothorax and small bowel obstruction. Large prospective studies are required to adjust for severity of disease, to reveal the true causative factors in order to minimize the risk on these surgical complications in both types of patients.
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Affiliation(s)
- Kim Heiwegen
- Division of Pediatric Surgery, Department of Surgery, Radboudumc-Amalia Children's Hospital, route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Ivo de Blaauw
- Division of Pediatric Surgery, Department of Surgery, Radboudumc-Amalia Children's Hospital, route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sanne M B I Botden
- Division of Pediatric Surgery, Department of Surgery, Radboudumc-Amalia Children's Hospital, route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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17
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Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany. CHILDREN-BASEL 2021; 8:children8020160. [PMID: 33672568 PMCID: PMC7924040 DOI: 10.3390/children8020160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 01/13/2023]
Abstract
Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for the years 2009–2013. Main outcome measures were incidence, survival and length of hospital stay. Follow-up was 12 months. 285 patients were included. The incidence of CDH was 2.73 per 10,000 live births. Overall mortality was 30.2%. A total of 72.1% of the fatalities occurred before surgery. Highest mortality (64%) was noted in patients who were admitted to specialized care later as the first day of life. Patients receiving surgical repair had a better prognosis (mortality: 10.8%). A total of 67 patients (23.5%) were treated with ECMO with a mortality of 41.8%. The median cumulative hospital stay among one-year survivors was 40 days and differed between ECMO- and non-ECMO-treated patients (91 vs. 32.5 days, p < 0.001). This is the largest German cohort study of CDH patients with a one-year follow-up. The ECMO subgroup showed a higher mortality. Another important finding is that delayed treatment in specialized care increases mortality. Prospective clinical registries are needed to elucidate the treatment outcomes in detail.
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18
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Kiblawi R, Zoeller C, Zanini A, Ure BM, Dingemann J, Kuebler JF, Schukfeh N. Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence. Eur J Pediatr Surg 2021; 31:54-64. [PMID: 33027837 DOI: 10.1055/s-0040-1716878] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The pros and cons of video-assisted thoracoscopic versus conventional thoracic surgery in infants and children are still under debate. We assessed reported advantages and disadvantages of video-assisted thoracoscopy in pediatric surgical procedures, as well as the evidence level of the available data. MATERIALS AND METHODS A systematic literature search was performed to identify manuscripts comparing video-assisted thoracoscopic and the respective conventional thoracic approach in classic operative indications of pediatric surgery. Outcome parameters were analyzed and graded for level of evidence (according to the Oxford Centre of Evidence-Based Medicine). RESULTS A total of 48 comparative studies reporting on 12,709 patients, 11 meta-analyses, and one pilot randomized controlled trial including 20 patients were identified. More than 15 different types of advantages for video-assisted thoracoscopic surgery were described, mostly with a level of evidence 3b or 3a. Most frequently video-assisted thoracoscopic surgery was associated with shorter hospital stay, shorter postoperative ventilation, and shorter time to chest drain removal. Mortality rate and severe complications did not differ between thoracoscopic and conventional thoracic pediatric surgery, except for congenital diaphragmatic hernia repair with a lower mortality and higher recurrence rate after thoracoscopic repair. The most frequently reported disadvantage for video-assisted thoracoscopic surgery was longer operative time. CONCLUSION The available data point toward improved recovery in pediatric video-assisted thoracoscopic surgery despite longer operative times. Further randomized controlled trials are needed to justify the widespread use of video assisted thoracoscopy in pediatric surgery.
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Affiliation(s)
- Rim Kiblawi
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Christoph Zoeller
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Andrea Zanini
- Department of Pediatric Surgery, University of Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
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19
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García HJ, Licona-Islas C, López-García N, Cabello HG, Galván-Sosa V. Experience of Minimally Invasive Surgery in Neonates with Congenital Malformations in a Tertiary Care Pediatric Hospital. J Indian Assoc Pediatr Surg 2020; 25:378-384. [PMID: 33487941 PMCID: PMC7815036 DOI: 10.4103/jiaps.jiaps_169_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/16/2019] [Accepted: 06/09/2020] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of this study is to report the experience with minimally invasive surgery (MIS) in neonates with congenital malformations in a tertiary care pediatric hospital. Materials and Methods: Design: descriptive study. All neonates undergoing MIS from 2013 to 2018 were included in the study. Perinatal data, characteristics of surgery, type and duration of analgesia, postoperative mechanical ventilation duration, postoperative hospitalization, and postoperative morbidity and mortality surgery-related rates were recorded. Results: Seventy-one neonates were included. Gestational age and weight at surgery ranged from 24 to 41 weeks and from 1350 g to 4830 g, respectively. Procedures performed were esophageal atresia/tracheoesophageal fistula repair, congenital diaphragmatic hernia repair, diaphragmatic plication, fundoplication/gastrostomy, intestinal atresia repair, and pancreatectomy. The median follow-up period was 14 months. Five neonates (7%) were converted to open, for surgical difficulties. Nine (12.6%) neonates had intraoperative complications, with decreased oxygen saturation as the most common complication. The median duration of analgesia and postoperative mechanical ventilation was 3 days in most procedures. The morbidity and mortality rates were 36.6% and 2.8%, respectively. Conclusions: In this first experience with MIS in neonates, the duration of analgesia and hospitalization was shorter for some procedures. However, intraoperative and postoperative complications were still high, which was possibly attributed to the learning curve. Thus, it is expected that the frequency of the complications presented in this study will be reduced in future.
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Affiliation(s)
- Heladia J García
- Research Unit of Analysis and Synthesis of the Evidence, Mexico City, México
| | - Carmen Licona-Islas
- Department of Neonatal Surgery, Pediatric Hospital, 21 Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, México
| | - Nadia López-García
- Neonatal Intensive Care Unit, Pediatric Hospital, 21 Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, México
| | - Héctor González Cabello
- Neonatal Intensive Care Unit, Pediatric Hospital, 21 Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, México
| | - Vladimir Galván-Sosa
- Neonatal Intensive Care Unit, Pediatric Hospital, 21 Century National Medical Center, Mexican Institute of Social Security (IMSS), Mexico City, México
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20
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Abello C, Varela MF, Oria M, Molinari T, Peiro JL. Innovative, Stabilizing Self-Expandable Patch for Easier and Safer Thoracoscopic Repair of Congenital Diaphragmatic Hernia. J Laparoendosc Adv Surg Tech A 2020; 30:1242-1247. [PMID: 32960151 DOI: 10.1089/lap.2020.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction: Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has become a popular approach and several benefits have been published. Patch closure requires demanding thoracoscopic skills and therefore primary closure with tight sutures is often pursued, which increases the risk of recurrence. The purpose of this study was to create and assess the performance of a new technique for thoracoscopic repair of CDH, which facilitates the surgical procedure. Materials and Methods: An innovative system for thoracoscopic repair of CDH with a novel patch was developed. The patch is self-expandable and offers a traction suture for stabilization, isolating and protecting the viscera. Its performance was assessed and compared with a conventional patch in an inanimate model of the disease through a quantitative and qualitative multivariate analysis. Results: Nine cases of CDH were repaired with each patch. The duration of the procedure was shorter (P < .05) and the level of difficulty was reported to be lower (P < .001) when using the self-expandable patch (SeP). The number of good quality knots was higher and adverse events were less common with this new technique. Conclusions: The stabilizing SeP offers safe and ergonomic performance for thoracoscopic CDH repair, facilitating the surgical technique. The main advantage is that it keeps the viscera isolated into the abdomen while offering a flap on the thoracic side for suturing in a practical manner, minimizing the risk of visceral injury and saving surgical time.
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Affiliation(s)
- Cristobal Abello
- Department of Pediatric Surgery, Clínica CMI Pediátrica International, Barranquilla, Colombia
| | - Maria Florencia Varela
- Pediatric General and Thoracic Surgery Division, Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
| | - Marc Oria
- Pediatric General and Thoracic Surgery Division, Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tomas Molinari
- Department of Pediatric Surgery, Clínica CMI Pediátrica International, Barranquilla, Colombia
| | - Jose L Peiro
- Pediatric General and Thoracic Surgery Division, Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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21
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Masahata K, Usui N, Shimizu Y, Takeuchi M, Sasahara J, Mochizuki N, Tachibana K, Abe T, Yamamichi T, Soh H. Clinical outcomes and protocol for the management of isolated congenital diaphragmatic hernia based on our prenatal risk stratification system. J Pediatr Surg 2020; 55:1528-1534. [PMID: 31864663 DOI: 10.1016/j.jpedsurg.2019.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/24/2019] [Accepted: 10/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to evaluate our prenatal risk stratification system for risk-adjusted management in fetuses with isolated congenital diaphragmatic hernia (CDH). METHODS Ninety-four infants prenatally diagnosed with isolated CDH treated between 1998 and 2017 at our institution were included in this retrospective single-center cohort study. RESULTS The patients were prenatally classified into four risk groups: Group A (n = 54), which consisted of infants with neither liver-up nor a contralateral lung-to-thorax transverse area (L/T) ratio <0.08. The infants in group A were divided into two subgroups: Group A-1 (n = 24) consisted of mild conditions; and Group A-2 (n = 30) consisted of severe conditions; Group B (n = 23), which consisted of infants with either liver-up or L/T ratio <0.08; and Group C (n = 17), which consisted of infants with both liver-up and L/T ratio <0.08. The rates of survival to discharge in Groups A-1, A-2, B, and C were 100.0%, 100.0%, 87.0%, and 58.8%, respectively. The rates of intact discharge were 91.7%, 90.0%, 52.1%, and 23.5%, respectively. CONCLUSIONS Our prenatal risk stratification system demonstrated a significant difference in the severity of postnatal status and clinical outcomes between the groups. STUDY TYPE Case Series, Retrospective Review. LEVELS OF EVIDENCE LEVEL IV.
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Affiliation(s)
- Kazunori Masahata
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan.
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yoshiyuki Shimizu
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Jun Sasahara
- Department of Obstetrics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Narutaka Mochizuki
- Department of Neonatology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Takatoshi Abe
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Taku Yamamichi
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Hideki Soh
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
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22
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Suply E, Rees C, Cross K, Elagami H, Blackburn S, Giuliani S, D'Souza R, David AL, Deprest J, Curry J, Eaton S, De Coppi P. Patch repair of congenital diaphragmatic hernia is not at risk of poor outcomes. J Pediatr Surg 2020; 55:1522-1527. [PMID: 31711747 DOI: 10.1016/j.jpedsurg.2019.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Recurrence of congenital diaphragmatic hernia (CDH) was retrospectively evaluated after correction with or without a patch in an institution where tension-free repair is advocated. METHODS Demographics and outcomes of patients with a postero-lateral CDH repaired (2000-2016) were analyzed (univariate tests and binary logistic regression adjusting for time since start of study, gender, defect side, liver herniation, patch, surgical approach, absence of postero-lateral rim and length of follow-up). RESULTS Of 203 patients, 107 received a patch (P), and 96 were not patched (NP). Groups were not different for gestational age birthweight, gender, defect side and minimally invasive approach rate. Preoperative ECMO incidence (P:29.9% vs. NP:2.1%, p < 0.01), liver herniation (P:57.0% vs. NP:22.9%, p < 0.01) and absence of a postero-lateral rim (P:61.7% vs. NP:8.3%, p < 0.01) were higher in the P group. The mortality rate was 10.8% (P:15.0% vs. NP:6.2%, p = 0.07). Recurrence was not different (P:9.3% vs. NP:4.2%, p = 0.15). Multivariate analysis showed that recurrence was higher after thoracoscopy compared to open (OR = 12.2 [2.2-68], p < 0.01); neither the use of patch (OR = 2.3, [0.5-10.4], p = 0.28) nor any other factors were associated with recurrence. CONCLUSION In this single centre series where tension-free repair was advocated, patch repair of CDH was not associated with higher recurrence, though access route was. TYPE OF STUDY Cohort Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Etienne Suply
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Clare Rees
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Kate Cross
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Hesham Elagami
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Simon Blackburn
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Stefano Giuliani
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Rashmi D'Souza
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Anna L David
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK; Centre for Prenatal Therapy, Institute for Women's Health, UCL, London, UK; Academic Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK; Centre for Prenatal Therapy, Institute for Women's Health, UCL, London, UK; Academic Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences KU Leuven, Leuven, Belgium
| | - Joe Curry
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Paolo De Coppi
- General Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK; Academic Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences KU Leuven, Leuven, Belgium; Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK.
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23
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Sidler M, Wong ZH, Eaton S, Ahmad N, Ong M, Morsi A, Rees CM, Giuliani S, Blackburn S, Curry JI, Cross KM, De Coppi P. Insufflation in minimally invasive surgery: Is there any advantage in staying low? J Pediatr Surg 2020; 55:1356-1362. [PMID: 32102738 DOI: 10.1016/j.jpedsurg.2019.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
AIM Minimally invasive repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) and congenital diaphragmatic hernia (CDH) is feasible and confers benefits compared to thoracotomy or laparotomy. However, carbon dioxide (CO2) insufflation can lead to hypercapnia and acidosis. We sought to determine the effect of lower insufflation pressures on patients' surrogate markers for CO2 absorption - arterial partial pressure of CO2 (PaCO2), end tidal CO2 (EtCO2) and pH. METHODS Single center retrospective review, including neonates without major cardiac anomaly. Selected patients formed 2 groups: Historical pressure (HP) group and low pressure (LP) group. We reported on the patients' preoperative characteristics that potentially confound the degree of CO2 absorption or elimination. Outcome measures were perioperative PaCO2, EtCO2, arterial pH and anesthetic time. RESULTS 30 patients underwent minimally invasive surgery for CDH and 24 patients for EA/TEF with similar distribution within the HP and LP group. For CDH patients as well as for EA/TEF patients, there were no significant differences in their preoperative characteristics or surgery duration comparing HP and LP groups. With a decrease in insufflation pressure in CDH patients, there were a significant decrease (p = 0.002) in peak PaCO2 and an improvement in nadir pH (p = 0.01). For the EA/TEF patients, the decrease in insufflation pressure was associated with a significant decrease (p = 0.03) in peak EtCO2. Considering all 54 patients, we found EtCO2 to be highly significantly inversely correlated with pH and positively correlated with intraoperative PaCO2 (p < 0.001). Baseline Hb was inversely correlated with mean EtCO2 (p < 0.001). CONCLUSION With lower insufflation pressures, CDH patients had significantly improved hypercapnia and acidosis, while EA/TEF patients had significantly reduced EtCO2. EtCO2 was correlated with acidosis and hypercapnia. TYPE OF STUDY Retrospective case control study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Martin Sidler
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom
| | - Zeng Hao Wong
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Simon Eaton
- Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom
| | - Nargis Ahmad
- Paediatric Anaesthesia, Great Ormond Street Hospital, London, United Kingdom
| | - Meydene Ong
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Ahmed Morsi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Clare M Rees
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Simon Blackburn
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Joseph I Curry
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Kate M Cross
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom.
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24
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Kotb M, Shehata M, Shehata S, Shehata S, Khairi A, Rabie A, Ghonaim T. Thoracoscopic Repair of Congenital Diaphragmatic Hernia: a Tale from Two Cities. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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Simple and safe thoracoscopic repair of neonatal congenital diaphragmatic hernia by a new modified knot-tying technique. Hernia 2019; 23:1275-1278. [PMID: 31317290 DOI: 10.1007/s10029-019-02003-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
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.
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26
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Vandewalle RJ, Yalcin S, Clifton MS, Wulkan ML. Biologic Mesh Underlay in Thoracoscopic Primary Repair of Congenital Diaphragmatic Hernia Confers Reduced Recurrence in Neonates: A Preliminary Report. J Laparoendosc Adv Surg Tech A 2019; 29:1212-1215. [PMID: 31219370 DOI: 10.1089/lap.2019.0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The purpose of this study was to determine if utilization of biologic mesh underlay during thoracoscopic congenital diaphragmatic hernia (CDH) primary repair (PR) results in reduced 5-year hernia recurrence rates. Methods: A retrospective review was completed for all primarily repaired CDH utilizing a thoracoscopic approach from January 1, 2003 to June 31, 2013. Patients were included in the study cohort if they had a thoracoscopic PR of their CDH without any mesh reinforcement or with biologic mesh underlay. Charts were then reviewed for no less than 5 years postoperatively for reports of clinical and/or radiographic hernia recurrence. The cumulative annual hernia recurrence as well as other demographic factors were analyzed. Results: Within the study period, 46 patients were identified that met study criteria. Three patients were lost to follow-up. Fifteen of the remaining patients (15/43: 34.9%) had a biologic underlay. Within the cohort, seven recurrences were noted within 5 years of the index procedure (7/43; 16.7%). Four recurrences occurred within the first postoperative year, and all occurred by the third postoperative year. One recurrence was in a patient with a biologic underlay at 4 months after repair. This was a clinically/radiographically silent 4 mm defect and noted at laparoscopy for another indication (1/15: 6.6%). The remainder occurred in primarily repaired patients without mesh reinforcement (6/28: 21.4%). Conclusions: Thoracoscopic PR of CDH can be successfully performed in select patients. The use of a biologic mesh underlay in this subset of patients appears to confer reduced hernia recurrence.
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Affiliation(s)
- Robert J Vandewalle
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Sule Yalcin
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew S Clifton
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Mark L Wulkan
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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27
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Li B, Li ST, Chen WB, Xia SL, Zhang FN, Sun CX. Thoracoscopic Repair by Simplified Mattress Sutures for Diaphragmatic Hernia in the Neonate When No Posterolateral Diaphragmatic Rim Exists. J Laparoendosc Adv Surg Tech A 2019; 29:710-713. [PMID: 31067209 DOI: 10.1089/lap.2018.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The aim of this retrospective study is to describe our initial experience by using new simplified mattress sutures with syringe needle for congenital diaphragmatic hernia (CDH) in neonates when no posterolateral rim of diaphragm exists. Methods: A retrospective review of the new simplified technique in 15 cases from February 2015 to February 2018 at a single institution was performed. In the procedure, two to three primary suture sites were taken from the relative intercostal region of the body surface. Two 2-0 nonabsorbable sutures around the rib were inserted between the anterior rim of the defect and the relative rib through a syringe needle. Knot tying was made extracorporally and the knots were under the skin of intercostals space. Results: Among the patients, 9 were male and 6 were female. The age was 10 minutes-1 day when admitted, 10 were term newborns, and 5 were premature. The mean operative time was 37.5 minutes (range, 25-60 minutes) for each CDH repair. No cases required conversion to open surgery, blood loss was minimal. The mean follow-up duration was 18.5 months (range 3-27 months), with no deaths, and no single case of recurrence. Conclusion: We have found this simple technique to be a useful adjunct in the thoracoscopic management of selected cases with CDH. It has the advantages of reduced operative time, simplicity, and feasibility and has the value of clinical popularization.
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Affiliation(s)
- Bing Li
- 1 Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Shi-Ting Li
- 2 Department of Thoracic Surgery, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, P.R. China
| | - Wei-Bing Chen
- 1 Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Shun-Lin Xia
- 1 Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Feng-Nian Zhang
- 1 Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Chun-Xia Sun
- 1 Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
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28
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Morsberger JL, Short HL, Baxter KJ, Travers C, Clifton MS, Durham MM, Raval MV. Parent reported long-term quality of life outcomes in children after congenital diaphragmatic hernia repair. J Pediatr Surg 2019; 54:645-650. [PMID: 29970249 DOI: 10.1016/j.jpedsurg.2018.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/18/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to determine long-term outcomes for congenital diaphragmatic hernia (CDH) patients including quality of life (QoL), symptom burden, reoperation rates, and health status. METHODS A chart review and phone QoL survey were performed for patients who underwent CDH repair between 2007 and 2014 at a tertiary free-standing children's hospital. Comprehensive outcomes were collected including subsequent operations and health status. Associations with QoL were tested using Wilcoxon Rank-Sum tests and Pearson correlation coefficients. RESULTS Of 102 CDH patients identified, 46 (45.1%) patient guardians agreed to participate with mean patient age of 5.8 (SD, 2.2) years at time of follow-up. Median PedsQLTM and PedsQLTM Gastrointestinal scores were 91.8 (IQR, 84.8-95.8) and 95.8 (IQR, 93.0-98.2), out of 100. Thoracoscopic repair was associated with higher PedsQLTM scores while defects with an intrathoracic stomach were associated with increased gas and bloating. No difference in QoL was found when comparing defect side, patch vs primary repair, prenatal diagnosis, extracorporeal membrane oxygenation, or recurrence. Older age weakly correlated with worse school functioning and heartburn. CONCLUSION Children with CDH have reassuring QoL scores. Given the correlation between older age and poor school function, longer follow-up of patients with CDH may be warranted. LEVEL OF EVIDENCE III (Retrospective comparative study).
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Affiliation(s)
- Jill L Morsberger
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Heather L Short
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Katherine J Baxter
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Matthew S Clifton
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Megan M Durham
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
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Hattori K, Takamizawa S, Miyake Y, Hatata T, Yoshizawa K, Furukawa T, Kondo Y. Preoperative sonographic evaluation of the defect size and the diaphragm rim in congenital diaphragmatic hernia - preliminary experience. Pediatr Radiol 2018; 48:1550-1555. [PMID: 29978294 DOI: 10.1007/s00247-018-4184-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/14/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sonographic assessment before congenital diaphragmatic hernia repair has rarely been studied. OBJECTIVE To evaluate the accuracy of preoperative ultrasound in measuring the defect size and in anticipating the presence of a rim and thereby to determine ultrasound's usefulness in informing the surgical approach for definitive repair of congenital diaphragmatic hernia. MATERIALS AND METHODS We performed a retrospective review of the medical records of seven children with left congenital diaphragmatic hernia who had undergone ultrasound and definitive repair between 2014 and 2017 at our institution. RESULTS The estimated defect size by ultrasound to the actual defect size measured intraoperatively for each case were as follows: 23 × 25 mm to 20 × 26 mm (case 1); 23 × 30 mm to 20 × 30 mm (case 2); 43 × 25 mm to 30 × 30 mm (case 3); 21 × 23 mm to 20 × 25 mm (case 4); 19 × 24 mm to 10 × 30 mm (case 5); 32 × 33 mm to 30 × 50 mm (case 6); and almost total absence to 40 × 50 mm (case 7). Presence or absence of each part of the diaphragm rim evaluated by ultrasound was almost identical with the actual intraoperative findings. According to the ultrasound findings, we performed a successful thoracoscopic repair in cases 1-5 with relatively small defects and presence of all parts of the rim or absence of only posterolateral rim. CONCLUSION There was good concordance between ultrasound findings and operative findings regarding the size of the defect and presence or absence of the diaphragm rim.
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Affiliation(s)
- Kengo Hattori
- Department of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino City, Nagano, 399-8288, Japan.
| | - Shigeru Takamizawa
- Department of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino City, Nagano, 399-8288, Japan
| | - Yuichiro Miyake
- Department of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino City, Nagano, 399-8288, Japan
| | - Tomoko Hatata
- Department of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino City, Nagano, 399-8288, Japan
| | - Katsumi Yoshizawa
- Department of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino City, Nagano, 399-8288, Japan
| | - Tomoko Furukawa
- Department of Radiology, Nagano Children's Hospital, Nagano, Japan
| | - Yoshiaki Kondo
- Department of Radiology, Nagano Children's Hospital, Nagano, Japan
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30
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Outcomes for thoracoscopic versus open repair of small to moderate congenital diaphragmatic hernias. J Pediatr Surg 2018; 53:635-639. [PMID: 29055487 DOI: 10.1016/j.jpedsurg.2017.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/29/2017] [Accepted: 09/02/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Indications for thoracoscopic versus open approaches to repair congenital diaphragmatic hernia (CDH) are unclear as the variability in defect size, disease severity and patient characteristics pose a challenge. Few studies use a patient and disease-matched comparison of techniques. We aimed to compare the clinical outcomes of open versus thoracoscopic repairs of small to moderate sized hernia defects in a low risk population. METHODS All neonates receiving CDH repair of small (type A) and moderate (type B) size defects at an academic children's hospital between 2006 and 2016 were retrospectively reviewed and analyzed. Patients <36weeks gestation, birth weight <1500g, or requiring extracorporeal life support were excluded. Demographics, including CDH severity index, and hernia characteristics were recorded. The primary outcome parameter was recurrence. Secondary outcomes included length of hospital stay, length of mechanical ventilation, time to goal feeds, and mortality. RESULTS The 51 patients receiving thoracoscopic (35) and open (16) repairs were similar in patient and hernia characteristics, with median 2-year follow-up for both groups. Patients with thoracoscopic repair had shorter hospital stay (16 vs. 23days, p=0.03), days on ventilator (5 vs. 12, p=0.02), days to start of enteral feeds (5 vs. 10, p<0.001), and days to goal feeds (11 vs. 20, p=0.006). Higher recurrence rates in the thoracoscopic groups (17.1% vs. 6.3%) were not statistically significant (p=0.28). Median time to recurrence was 88days for the open repair and 183days (IQR 165-218) for the thoracoscopic group. There were no mortalities in either group. CONCLUSIONS In low risk patients born with small to moderate size defects, a thoracoscopic approach was associated with decreased hospital length of stay, mechanical ventilation days, and time to feeding; however, there was a trend towards higher recurrence rates. LEVEL OF EVIDENCE Level III.
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31
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Poupalou A, Vrancken C, Vanderveken E, Steyaert H. Use of Nonabsorbable Spiral Tacks for Mesh Reinforcement in Thoracoscopic Repair of Congenital Diaphragmatic Hernia. European J Pediatr Surg Rep 2018; 6:e27-e31. [PMID: 29577002 PMCID: PMC5864520 DOI: 10.1055/s-0037-1612618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/03/2017] [Indexed: 01/17/2023] Open
Abstract
Thoracoscopic prosthetic repair of congenital diaphragmatic hernia (CDH) is a well-established and safe technique in experienced hands but the patching procedure is technically demanding and time consuming. To address the challenges associated with this process (confined working space and restricted time), the aim of this article is to assess the potential improvements in feasibility, efficacy, and safety of patch fixation by using nonabsorbable helicoidal tacks in neonates and infants for the repair of large CDH by thoracoscopy. The new technique has all the advantages of minimal invasive surgery in very young children combined with the advantages of reduced operating time and increased simplicity, and may be a good option in cases of recurrence.
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Affiliation(s)
- Anna Poupalou
- Department of Pediatric Surgery/ Pediatrics, Université Libre de Bruxelles (ULB), Hôpital CHU St Pierre, Bruxelles, Belgium
- ChirurgiePédiatrique, Université Libre de Bruxelles (ULB), Hôpital HUDERF, Bruxelles, Belgium
| | - Celine Vrancken
- ChirurgiePédiatrique, Université Libre de Bruxelles (ULB), Hôpital HUDERF, Bruxelles, Belgium
| | - Erwin Vanderveken
- ChirurgiePédiatrique, Université Libre de Bruxelles (ULB), Hôpital HUDERF, Bruxelles, Belgium
| | - Henri Steyaert
- ChirurgiePédiatrique, Université Libre de Bruxelles (ULB), Hôpital HUDERF, Bruxelles, Belgium
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Morini F, Valfrè L, Bagolan P. Long-term morbidity of congenital diaphragmatic hernia: A plea for standardization. Semin Pediatr Surg 2017; 26:301-310. [PMID: 29110826 DOI: 10.1053/j.sempedsurg.2017.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Congenital diaphragmatic hernia (CDH) survivors present long-term morbidities in several systems, including the neurodevelopmental, gastrointestinal, pulmonary, and musculoskeletal ones, and CDH long-term sequelae are increasingly being recognized. Due to high co-morbidity, health related quality of life in a significant proportion of CDH patients might be compromised. As a consequence of consciousness on the long-term sequelae of CDH survivors, and their consequences for life, several follow-up programs were brought to life worldwide. In this review, we will summarize the long-term sequelae of CDH survivors, the impact of new treatments, and analyze the consistency of follow-up programs.
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Affiliation(s)
- Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Valfrè
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Okazaki T, Okawada M, Ishii J, Koga H, Miyano G, Doi T, Ogasawara Y, Lane GJ, Yamataka A. Intraoperative ventilation during thoracoscopic repair of neonatal congenital diaphragmatic hernia. Pediatr Surg Int 2017; 33:1097-1101. [PMID: 28803335 DOI: 10.1007/s00383-017-4143-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the optimal ventilation mode during thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH), we compared high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV). METHODS Twenty-three neonatal CDH cases who underwent TR without intraoperative inhalation of nitric oxide at our institution between 2007 and 2016 were reviewed. Patients were initially ventilated with HFOV, which was converted to CMV if the HFOV settings were decreased to FiO2 <0.4, stroke volume <4 mL/kg and mean airway pressure <12 cmH2O. Arterial blood gases in the perioperative period were compared between HFOV and CMV. RESULTS Seventeen patients were ventilated with HFOV (group I), and six patients were ventilated with CMV (group II). Preoperative PaCO2 was significantly higher and pH was significantly lower in group I compared with group II. In both groups I and II, intraoperative PaCO2 increased significantly and pH decreased significantly compared with preoperation. Although intraoperative PaCO2 and pH were not different between the groups, group II showed greater worsening of intraoperative PaCO2 and pH as compared to their respective preoperative values. CONCLUSIONS HFOV seems to prevent deterioration of hypercapnia and acidosis to a greater extent than CMV during TR in neonatal cases of CDH, although patients can also be ventilated with CMV.
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Affiliation(s)
- Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan. .,Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Manabu Okawada
- Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Junya Ishii
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan.,Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Koga
- Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Go Miyano
- Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takashi Doi
- Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuki Ogasawara
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan.,Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Geoffrey J Lane
- Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Kohli N, Mitreski G, Yap CH, Leong M. Massive symptomatic right-sided Bochdalek hernia in an adult man. BMJ Case Rep 2016; 2016:bcr-2016-217432. [PMID: 27852660 DOI: 10.1136/bcr-2016-217432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.
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Affiliation(s)
- Naman Kohli
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Goran Mitreski
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Cheng-Hon Yap
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Matthew Leong
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
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Snoek KG, Reiss IKM, Greenough A, Capolupo I, Urlesberger B, Wessel L, Storme L, Deprest J, Schaible T, van Heijst A, Tibboel D. Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update. Neonatology 2016; 110:66-74. [PMID: 27077664 DOI: 10.1159/000444210] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/25/2016] [Indexed: 11/19/2022]
Abstract
In 2010, the congenital diaphragmatic hernia (CDH) EURO Consortium published a standardized neonatal treatment protocol. Five years later, the number of participating centers has been raised from 13 to 22. In this article the relevant literature is updated, and consensus has been reached between the members of the CDH EURO Consortium. Key updated recommendations are: (1) planned delivery after a gestational age of 39 weeks in a high-volume tertiary center; (2) neuromuscular blocking agents to be avoided during initial treatment in the delivery room; (3) adapt treatment to reach a preductal saturation of between 80 and 95% and postductal saturation >70%; (4) target PaCO2 to be between 50 and 70 mm Hg; (5) conventional mechanical ventilation to be the optimal initial ventilation strategy, and (6) intravenous sildenafil to be considered in CDH patients with severe pulmonary hypertension. This article represents the current opinion of all consortium members in Europe for the optimal neonatal treatment of CDH.
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Affiliation(s)
- Kitty G Snoek
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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