Surgical intervention for congenital diaphragmatic hernia: open versus thoracoscopic surgery

Purpose To compare open repair (OR) with thoracoscopic repair (TR) for congenital diaphragmatic hernia (CDH) in neonates. Methods Twenty-four neonatal CDH cases diagnosed prenatally or within 6 h of birth at our institute from 2002 to 2012 with mild pulmonary hypertension managed without inhaled nitric oxide, were studied. OR was routine until 2006 ( n = 14; L:R = 12:2) and TR became routine in 2007 ( n = 10; L:R = 10:0). All subjects had identical management. Results Gestational age at birth: OR 37.4 ± 1.6 vs. TR: 38.3 ± 1.1 weeks ( p = 0.10); birth weight 2,636 ± 490 vs. 2,887 ± 429 grams ( p = 0.20); preoperative A-aDO 2 : 308 ± 200 vs. 331 ± 195 mmHg ( p = 0.79); and operating time (min): 161 ± 42 vs. 194 ± 76 ( p = 0.27). In TR, intraoperative cardiopulmonary status was stable, intraoperative hemorrhage was significantly less (4.8 ± 6.0 vs. 1.1 ± 0.1 grams; p = 0.038), wound cosmesis was excellent without surgical site infections, while, maximum postoperative CRP (2.0 ± 1.5 vs. 1.5 ± 1.1 mg/dL; p = 0.30), commencement of enteral feeding (6.9 ± 2.8 vs. 5.6 ± 2.8 days; p = 0.27), and length of postoperative hospitalization (36 ± 22 vs. 34 ± 12 days; p = 0.66) were improved, but not significantly. One OR case required surgery for intestinal obstruction. Conclusions Thoracoscopic repair appears to be as effective as OR for treating selected cases of CDH in neonates, with excellent wound cosmesis.