Our Summary

This research paper discusses a new surgical technique for repairing congenital diaphragmatic hernias (CDH), a birth defect that affects the diaphragm. The traditional method of repair is open surgery, but this paper focuses on a less invasive procedure called thoracoscopic repair (TR). TR has been linked with a higher rate of recurrence, meaning the hernia returns after the surgery.

The new strategy, called “tension-free TR”, involves the use of an oversized patch to reconstruct the diaphragm and a new type of suturing (stitching) that leaves no gaps. The researchers also developed a new technique for doing the stitching outside of the body, using a commercially available needle.

The researchers tested this new strategy on 11 patients between 2017 and 2021. They found that in 8 patients, they were able to use the patch and none of the surgeries had to be converted to open surgery due to any technical problems. Only one patient experienced a recurrence of the hernia, but they were successfully re-operated on using TR. All patients recovered well after surgery.

In conclusion, the researchers suggest that this new tension-free TR strategy could make suturing easier and reduce the risk of the hernia returning after surgery.

FAQs

  1. What is the recurrence rate of congenital diaphragmatic hernia after thoracoscopic repair?
  2. What is the “tension-free TR of CDH” strategy and how does it improve the effectiveness of CDH repair?
  3. What is the role of an oversized patch and gapless suturing in the tension-free thoracoscopic repair of CDH?

Doctor’s Tip

One helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to follow postoperative care instructions closely, including avoiding heavy lifting or strenuous activities for a certain period of time to allow for proper healing. It is also important to attend follow-up appointments to monitor recovery progress and address any concerns or complications that may arise. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help support overall recovery and long-term health after CDH repair surgery.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) are typically recommended for repair surgery, especially those who are experiencing symptoms such as respiratory distress, feeding difficulties, or failure to thrive. In this study, patients who underwent thoracoscopic repair (TR) of CDH were evaluated for the effectiveness of a tension-free technique for quality improvement. The study found that tension-free TR combined with extracorporeal closure could reduce the difficulty of suturing and the risk of recurrence of CDH. Patients with CDH who may benefit from this approach include those with a high risk of recurrence or those who are not suitable candidates for open surgery.

Timeline

  • Before congenital diaphragmatic hernia repair:
  1. Diagnosis of congenital diaphragmatic hernia through prenatal ultrasound or after birth
  2. Monitoring of the patient’s condition and preparation for surgery
  3. Evaluation of the patient’s overall health and surgical risks
  4. Discussion of treatment options with the medical team and family
  5. Consent for surgery and preoperative tests and preparations
  • After congenital diaphragmatic hernia repair:
  1. Surgery to repair the hernia, either through open or thoracoscopic method
  2. Postoperative monitoring in the hospital for any complications or recurrence
  3. Pain management and wound care
  4. Gradual introduction of feeds and monitoring of bowel function
  5. Follow-up appointments with the medical team for long-term monitoring and care
  6. Rehabilitation and support for the patient and family as needed.

What to Ask Your Doctor

  1. What is the success rate of thoracoscopic repair for congenital diaphragmatic hernia compared to open surgery?
  2. What is the likelihood of recurrence after undergoing thoracoscopic repair for congenital diaphragmatic hernia?
  3. What is the recovery process like after thoracoscopic repair for congenital diaphragmatic hernia?
  4. Are there any potential complications or risks associated with thoracoscopic repair for congenital diaphragmatic hernia?
  5. How long will I need to stay in the hospital after undergoing thoracoscopic repair for congenital diaphragmatic hernia?
  6. What type of follow-up care will be needed after undergoing thoracoscopic repair for congenital diaphragmatic hernia?
  7. Are there any restrictions or limitations on activities following thoracoscopic repair for congenital diaphragmatic hernia?
  8. Are there any long-term effects or implications of undergoing thoracoscopic repair for congenital diaphragmatic hernia?

Reference

Authors: Deguchi K, Watanabe M, Yoneyama T, Masahata K, Nomura M, Saka R, Yamanaka H, Kamiyama M, Ueno T, Tazuke Y, Okuyama H. Journal: Surg Today. 2023 May;53(5):640-646. doi: 10.1007/s00595-022-02609-1. Epub 2022 Nov 4. PMID: 36333435