Our Summary

This study looked at two different ways to repair a birth defect called a congenital diaphragmatic hernia (CDH), where a baby’s diaphragm doesn’t form properly, allowing abdominal organs to move into the chest. The two methods are a traditional ‘open’ surgery and a less invasive ’thoracoscopic’ surgery, which uses a camera and small instruments inserted through tiny incisions.

The researchers reviewed the medical records of 54 infants who had either type of surgery over 8.5 years. They mainly wanted to see if the hernia came back after surgery, but they also looked at other factors like how much carbon dioxide built up in the body during surgery, how long the babies had to stay in hospital, and what complications happened after surgery.

Out of 54 infants, 25 had the less invasive surgery. Two of the babies who had the traditional surgery had their hernia come back (a rate of 3.7%). When it came to operation time and carbon dioxide levels, there was no difference between the two groups. However, the babies who had the less invasive surgery had a shorter hospital stay. Four of the babies who had the traditional surgery developed new hernias and five had bowel obstructions. No long-term complications were found in the babies who had the less invasive surgery.

The researchers concluded that the less invasive surgery is safe and outcomes were similar to the traditional surgery. In fact, the less invasive surgery may avoid some of the complications of the traditional surgery. In their group of patients, none of the less invasive surgeries resulted in the hernia coming back.

FAQs

  1. What is the recurrence rate of congenital diaphragmatic hernia after open repair surgery?
  2. How does the thoracoscopic repair method for a congenital diaphragmatic hernia compare to the open repair method in terms of safety and outcomes?
  3. Are there any long-term complications identified in the thoracoscopic cohort for congenital diaphragmatic hernia repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to discuss the potential benefits of thoracoscopic repair, such as improved cosmesis and potentially avoiding long-term complications associated with open repair. It is important to consider all options and discuss them with your healthcare provider to determine the best approach for your individual case.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who are recommended for repair typically include neonates and infants who have been diagnosed with a diaphragmatic hernia. In this study, the patients who underwent thoracoscopic CDH repair were infants with CDH who were deemed suitable candidates for this minimally invasive surgical approach. Patients with CDH may present with respiratory distress and other symptoms related to the herniated organs, and repair is typically recommended to correct the hernia and prevent complications such as bowel obstruction and recurrence. Thoracoscopic CDH repair may be recommended for select neonates and infants who are deemed suitable candidates for this minimally invasive approach.

Timeline

Before congenital diaphragmatic hernia repair, a patient may experience symptoms such as difficulty breathing, respiratory distress, and feeding difficulties. Diagnosis is typically made through prenatal ultrasound or shortly after birth. The patient may undergo stabilization and management of their symptoms before surgery.

After congenital diaphragmatic hernia repair, the patient will be closely monitored for complications such as recurrence of the hernia, respiratory issues, and feeding difficulties. They may require a hospital stay for monitoring and recovery. Long-term follow-up is important to monitor for any potential complications or issues related to the surgery. In the case of thoracoscopic repair, patients may experience improved cosmesis and potentially avoid some of the long-term complications associated with open repair.

What to Ask Your Doctor

  1. What are the potential risks and benefits of thoracoscopic versus open repair for congenital diaphragmatic hernia?
  2. How will the choice of repair method impact the likelihood of recurrence?
  3. What is the typical recovery time and postoperative care for each type of repair?
  4. Are there any long-term complications or considerations specific to thoracoscopic repair that I should be aware of?
  5. What factors will determine if I am a candidate for thoracoscopic repair versus open repair?
  6. How many procedures of this type have you performed, and what is your experience and success rate with each method?
  7. Are there any specific preoperative or postoperative instructions I should follow to optimize my outcome?
  8. What is the expected outcome and prognosis for my child following either type of repair?
  9. Are there any alternative treatment options for congenital diaphragmatic hernia that I should consider?
  10. How will the choice of repair method impact the potential for future complications or surgeries related to the hernia repair?

Reference

Authors: Tyson AF, Sola R Jr, Arnold MR, Cosper GH, Schulman AM. Journal: J Laparoendosc Adv Surg Tech A. 2017 Nov;27(11):1209-1216. doi: 10.1089/lap.2017.0298. Epub 2017 Oct 4. PMID: 28976813