Our Summary

This research paper is about a study that compared two surgical methods for treating newborn babies with a birth defect called congenital diaphragmatic hernia (CDH), where there’s a hole in the diaphragm. The two methods are thoracoscopic repair (TR) - a minimally invasive surgery using a camera and small tools, and open repair (OR) - a traditional open surgery.

The study looked at 524 babies with this condition, treated in 15 different hospitals in Japan from 2006 to 2018. Of these, 57 babies had the TR procedure and 467 had the OR procedure. Some babies who started with the TR procedure had to switch to the OR procedure due to technical difficulties, and these babies were not included in the final analysis.

The results showed that the survival rate at 180 days was about the same for both procedures. The rate of the hernia coming back was also similar for both procedures. However, when the researchers took into account other factors like how premature the babies were, where the liver and stomach were positioned, and whether a certain kind of shunt was used, they found that babies who had the TR procedure had a shorter hospital stay and were less likely to develop chronic lung disease.

In conclusion, the study suggests that the TR procedure can be a safe and potentially better option for treating selected newborns with CDH.

FAQs

  1. What is congenital diaphragmatic hernia (CDH) and what were the two surgical methods used for its treatment in the study?
  2. What were the key findings of the comparison between thoracoscopic repair (TR) and open repair (OR) for treating CDH in newborn babies?
  3. According to the study, how did the location of the liver and stomach and the use of a certain type of shunt impact the outcomes of the surgical procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to discuss with their medical team the possibility of thoracoscopic repair (TR) as a minimally invasive surgical option. This study suggests that TR may lead to a shorter hospital stay and lower risk of chronic lung disease compared to open repair (OR) in certain cases. It’s important to have a thorough discussion with your healthcare providers to determine the best treatment option for your baby.

Suitable For

Typically, patients who are recommended for congenital diaphragmatic hernia repair are newborn babies with this condition. In this study, the researchers specifically looked at newborn babies with CDH who required surgical intervention. The study included a total of 524 babies with CDH, with 57 of them undergoing thoracoscopic repair (TR) and 467 undergoing open repair (OR).

Factors such as the severity of the hernia, the position of the liver and stomach, and the use of a shunt were taken into account when determining which surgical method to use. The study found that babies who underwent the TR procedure had a shorter hospital stay and were less likely to develop chronic lung disease compared to those who underwent the OR procedure.

Overall, patients who are recommended for congenital diaphragmatic hernia repair are newborn babies with CDH who require surgical intervention. The choice between thoracoscopic repair and open repair may depend on various factors specific to each case, and a multidisciplinary team of healthcare providers will assess and determine the most appropriate treatment approach for each individual patient.

Timeline

Before congenital diaphragmatic hernia repair:

  • Diagnosis of CDH through prenatal ultrasound or after birth
  • Monitoring of baby’s condition and lung development
  • Possible placement of a chest tube or ECMO (extracorporeal membrane oxygenation) for respiratory support
  • Discussion with medical team about treatment options and risks

After congenital diaphragmatic hernia repair:

  • Surgery to repair the diaphragmatic hernia, either through thoracoscopic repair or open repair
  • Post-operative care in the neonatal intensive care unit (NICU)
  • Monitoring for complications such as infection, respiratory issues, or hernia recurrence
  • Rehabilitation and follow-up care to monitor long-term outcomes and developmental progress.

What to Ask Your Doctor

  1. What are the risks and benefits of thoracoscopic repair (TR) compared to open repair (OR) for congenital diaphragmatic hernia?

  2. How does the recovery process differ between TR and OR for congenital diaphragmatic hernia repair?

  3. What factors would make a baby a good candidate for thoracoscopic repair (TR) versus open repair (OR) for congenital diaphragmatic hernia repair?

  4. Are there any long-term implications or differences in outcomes between TR and OR for congenital diaphragmatic hernia repair?

  5. How common is it for a baby to need to switch from thoracoscopic repair (TR) to open repair (OR) during the surgery, and what are the reasons for this switch?

  6. Are there any specific considerations or precautions that need to be taken for babies undergoing thoracoscopic repair (TR) for congenital diaphragmatic hernia repair?

  7. How experienced is the surgical team in performing thoracoscopic repair (TR) for congenital diaphragmatic hernia, and what is their success rate with this procedure?

  8. What follow-up care or monitoring is needed for a baby who undergoes thoracoscopic repair (TR) for congenital diaphragmatic hernia repair?

  9. Are there any alternative treatment options or approaches for congenital diaphragmatic hernia repair that should be considered?

  10. Can you provide more information about the specific techniques used in thoracoscopic repair (TR) for congenital diaphragmatic hernia, and how they compare to open repair (OR)?

Reference

Authors: Okawada M, Ohfuji S, Yamoto M, Urushihara N, Terui K, Nagata K, Taguchi T, Hayakawa M, Amari S, Masumoto K, Okazaki T, Inamura N, Toyoshima K, Inoue M, Furukawa T, Yokoi A, Kanamori Y, Usui N, Tazuke Y, Saka R, Okuyama H; Japanese Congenital Diaphragmatic Hernia Study Group. Journal: Surg Today. 2021 Oct;51(10):1694-1702. doi: 10.1007/s00595-021-02278-6. Epub 2021 Apr 20. PMID: 33877452