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

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.