A comparative assessment of open and laparoscopic techniques in managing congenital diaphragmatic hernias in newborns



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. The authors share their experience in managing congenital diaphragmatic hernias (CDH) in newborns with open and thoracoscopic techniques.

Material and methods. From 2012 to 2022, 46 newborns with CDH were admitted to Kuraev Children’s Republican Clinical Hospital in Makhachkala (Russia). 5 children died before surgery, they were excluded from the study. In order to compare outcomes after treatment, all children operated on by the authors were divided into two groups depending on the technique of surgical CDH correction. Newborns from Group 1 (n = 23; 56%) were operated with open access. Newborns from Group 2 (n = 18; 44%) were operated with thoracoscopic access.

Results. A comparative evaluation of outcomes after thoracoscopic and open techniques for correcting CDH was made. By the literature, the overall survival rate of children with CDH has increased from 50–60% to 80–90%. The author consider, that it is largely due to the application of extracorporeal membrane oxygenation (ECMO) and nitric oxide to compensate pulmonary hypertension which is the main factor decreasing the postoperative mortality. In this case, physicians prescribed Sildenafil; the survival rate in Group 1 was 48% and in Group 2 – 67%. The authors noted that the mortality rate depended on the size of diaphragm dome defect, on the number of abdominal organs in the pleural cavity. Besides, the place where a child was operated on – in the resuscitation department or not – was also an important factor.

Conclusion. Thoracoscopy is a preferred approach for managing CDH because it does not need dissection of a large array of muscles; otherwise, later, in the postoperative period, it can impair the respiratory function. Early postoperative mortality in newborns is caused by hemodynamic disorders, so it is recommended to perform surgical interventions in this group of patients in the resuscitation department. To prevent hemodynamic disorders, it is recommended to install a pleural drainage intraoperatively in all patients with CDH. The authors underline that in their study postoperative course, rate of intraoperative and postoperative complications, as well as mortality rate did not have any statistically significant differences in the compared groups (p>0.05). Despite a marked progress in CDH management, large diaphragm defects still is an unsolved problem.

About the authors

S. A. Gebekova

Dagestan State Medical University; Kuraev Children’s Republican Clinical Hospital

Author for correspondence.
Email: safffrat@mail.ru

Safat А. Gebekova, MD, PhD, pediatric surgeon, department of pediatric surgery

367000, Makhachkala

367027, Makhachkala

Россия

B. M. Makhachev

Dagestan State Medical University; Kuraev Children’s Republican Clinical Hospital

Email: fake@neicon.ru

367000, Makhachkala

367027, Makhachkala

Россия

F. V. Meilanova

Dagestan State Medical University

Email: fake@neicon.ru

367000, Makhachkala

Россия

A. D. Magomedov

Dagestan State Medical University; Kuraev Children’s Republican Clinical Hospital

Email: fake@neicon.ru

367000, Makhachkala

367027, Makhachkala

Россия

V. T. Ashurbekov

Dagestan State Medical University

Email: fake@neicon.ru

367000, Makhachkala

Россия

A.  S. Saidmagomedova

Dagestan State Medical University

Email: fake@neicon.ru

367000, Makhachkala

Россия

References

  1. Ашкрафт К.У., Холдер Т.М. Детская хирургия. Практическое руководство в 3-х томах. СПб.: ИЧП «Хардфорд»; 1996.
  2. Красовская Т.В., Кучеров Ю.И., Голоденко Н.В. и др. Оптимизация диагностических и лечебных программ в хирургии новорождённых на современном этапе. Хирургия. 2003; (7): 29–31.
  3. Becmeur F., Reinberg O., Dimitriu C. Thoracoscopic repair of congenital diaphragmatic hernia in children. Semin. Pediatr. Surg. 2007; 16(4): 238-44.
  4. Van der Zee D.C., Bax N.M. Laparoscopic repair of congenital diaphragmatic hernia in a six-month-old child. Surg. Endosc. 1995; 9: 1001–3.
  5. Смирнова С.В., Разумовский А.Ю., Мокрушина О.Г. Современные способы коррекции врождённых диафрагмальных грыж у новорождённых. Вопросы практической педиатрии. 2012; 7(2): 30–4.
  6. Lally K.P., Lally P.A., Lasky R.E. Congenital Diaphragmatic Hernia Group. Defect size determines survival in infants with congenital daiaphragmatic hernia. Pediatrics. 2007; 120: 651–7.
  7. Morini F., Bagolan P. Surgical Techniques in congenital diaphragmatic hernia. J. Pediatr. Surg. 2012; 22: 355–63.
  8. Downard C.D., Jaksic T., Garza J.J. et al. Analysis of an improved survival rate for congenital diaphragmatic hernia. J. Pediatr. Surg. 2003; 38: 729–32.
  9. Meehan J.J., Sandler A. Robotic repair of a Bochdalek congenital diaphragmatic hernia in a small neonate: robotic advantages and limitations. J. Pediatr Surg. 2007; 42(10): 1757–60.
  10. Silen M.L., Canvasser D.A., Kurkchubasche A.G. et al. Videoassisted thoracic surgical repair of foramen of Bochdalec hernia. Ann. Thorac. Surg. 1995; 60: 448–50.
  11. Liem N.T. Thoracoscopic surgery for congenital diaphragmatic hernia: a report of nine cases. Asian J. Surg. 2003; 26(4): 210–2.
  12. Jeffrey W., Jason C., Gross E. Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study. J. Pediatr. Surg. 2010; 11: 48.
  13. Cass D.L. Fetal surgery for congenital diaphragmatic hernia: the North American experience. Semin Perinatol. 2005; 29: 104–11.
  14. Yang E.Y., Allmendinger N., Johnson S.M., Chen C., Wilson J.M., Fishman S.J.. Neonatal thorascopic repair of congeninal diaphragmatic hernia: selection criteria for successful outcome. J. Pediatr Surg. 2005; 40(9): 1369–75.
  15. Khan A.M., Lally K.P. The role of extracorporeal membrane oxygenation in the management of infants with congenital diaphragmatic hernia. Semin Perinatol. 2005; 29: 118–22.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies