Our Summary

This research paper is about a study that examined the use of thoracoscopy, a less invasive surgical technique, to repair congenital diaphragmatic hernia (CDH) in patients who have undergone extracorporeal membrane oxygenation (ECMO), a treatment that uses a machine to take over the work of the lungs and sometimes the heart. CDH is a birth defect where there is a hole in the diaphragm, the muscle that separates the chest from the abdomen.

The study reviewed cases from 2001 to 2015, looking at patients who had this type of surgery after ECMO treatment. They found that the thoracoscopic approach was successful in 28% of cases. They also found that patients tolerated the pressure necessary for the procedure well, and there was no significant increase in the level of carbon dioxide in the body during the operation.

One patient in the thoracoscopic group died and another had a large accumulation of air in the chest cavity. In the group where the procedure had to be changed to a more conventional open surgery, there was one significant case of air in the chest cavity and three instances of fluid buildup.

Patients who had the thoracoscopic surgery were able to breathe on their own without a ventilator an average of 5.6 days after surgery, compared to 19.4 days for those who had the open surgery. The rate of the hernia coming back was the same in both groups – 20%.

The study concluded that thoracoscopic repair of CDH is safe and feasible after ECMO treatment, without increasing risks during surgery or death. It also found that compared to open surgery, the thoracoscopic approach significantly reduces the time it takes for patients to breathe on their own after surgery, with no difference in the chance of the hernia coming back.

FAQs

  1. What is the success rate of thoracoscopic surgery in repairing congenital diaphragmatic hernia after ECMO treatment?
  2. How does the recovery time from thoracoscopic surgery compare to that of open surgery for congenital diaphragmatic hernia repair?
  3. Does thoracoscopic surgery increase the risk of complications or death when used to repair congenital diaphragmatic hernia after ECMO treatment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to discuss with their healthcare team the possibility of using thoracoscopy as a less invasive surgical option, especially if they have undergone ECMO treatment. This technique has been shown to be safe and effective in repairing CDH, with a quicker recovery time compared to traditional open surgery. It’s important for patients to weigh the risks and benefits of different surgical approaches with their medical team to make an informed decision about their treatment.

Suitable For

Patients who are typically recommended for congenital diaphragmatic hernia repair are those who have undergone ECMO treatment and have a CDH that requires surgical intervention. In this study, the patients who underwent thoracoscopic repair after ECMO treatment had successful outcomes and were able to breathe on their own sooner than those who underwent open surgery. This suggests that thoracoscopic repair may be a viable option for patients with CDH who have undergone ECMO treatment.

Timeline

Before congenital diaphragmatic hernia repair:

  1. Diagnosis of congenital diaphragmatic hernia through prenatal ultrasound or after birth.
  2. Evaluation of the severity of the hernia and associated complications.
  3. Stabilization of the patient’s condition with supportive measures such as ventilation and ECMO in severe cases.
  4. Preparation for surgery, including discussion of risks and benefits.

After congenital diaphragmatic hernia repair:

  1. Recovery in the hospital, with monitoring of breathing, feeding, and overall condition.
  2. Gradual weaning off of mechanical ventilation or ECMO support.
  3. Monitoring for any complications such as infection, recurrence of hernia, or respiratory issues.
  4. Follow-up appointments with healthcare providers to track long-term outcomes and development.
  5. Potential need for additional surgeries or interventions depending on the individual case.
  6. Rehabilitation and support for the patient and family to adjust to any long-term effects of the CDH repair.

What to Ask Your Doctor

Some questions a patient should ask their doctor about congenital diaphragmatic hernia repair include:

  1. Is thoracoscopic repair a suitable option for my specific case of congenital diaphragmatic hernia?
  2. What are the potential risks and complications associated with thoracoscopic repair compared to open surgery?
  3. How experienced are you in performing thoracoscopic repair for congenital diaphragmatic hernia?
  4. How long is the recovery process expected to be for thoracoscopic repair compared to open surgery?
  5. Will I need additional treatments or therapies after the surgery, such as physical therapy or respiratory support?
  6. Are there any long-term effects or complications I should be aware of after undergoing thoracoscopic repair for congenital diaphragmatic hernia?
  7. What is the success rate of thoracoscopic repair in terms of preventing the hernia from recurring?
  8. How soon after surgery can I expect to be able to breathe on my own without the assistance of a ventilator?
  9. Are there any specific dietary or lifestyle changes I should make to promote healing and recovery after thoracoscopic repair?
  10. Are there any support groups or resources available for patients who have undergone thoracoscopic repair for congenital diaphragmatic hernia?

Reference

Authors: Schlager A, Arps K, Siddharthan R, Glenn I, Hill SJ, Wulkan ML, Keene SD, Clifton MS. Journal: J Laparoendosc Adv Surg Tech A. 2018 Jun;28(6):774-779. doi: 10.1089/lap.2016.0583. Epub 2018 Mar 12. PMID: 29641364