Holcomb George W, Ostlie Daniel J, Miller Kelly A
Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108-4698, USA.
J Pediatr Surg. 2005 Aug;40(8):E1-5. doi: 10.1016/j.jpedsurg.2005.05.028.
Laparoscopic repair of congenital diaphragmatic hernias has been sparsely reported. Moreover, each report has primarily been a single operative case. In most of the reports, prosthetic mesh has not been used, and when used, it has been nonabsorbable in nature. Most of these case reports have documented only a few months of clinical follow-up.
After institutional review board approval (No. 01-12-115X), the clinical course and outcome of 3 patients undergoing laparoscopic repair of foramen of Morgagni and Bochdalek hernias using 4-ply Surgisis soft tissue graft (Cook Inc, Bloomington, Ind) were reviewed to determine if this approach is appropriate.
In 2001, 2 patients, ages 9 months and 14 years, underwent laparoscopic foramen of Morgagni repair and one 5-day-old underwent laparoscopic foramen of Bochdalek repair using Surgisis soft tissue graft as a patch to close the diaphragmatic defects because there was too much tension with primary repair. In each case, the prosthesis was secured to the rim of the defect using interrupted silk sutures tied intracorporally. The mean operative time for repair of the Morgagni defects was 230 minutes with a postoperative discharge of 1 and 2 days. For the foramen of Bochdalek repair, the operative time was 204 minutes, and the patient was discharged at 3 weeks. No complications have occurred during or after any of the procedures, but the oldest patient underwent diagnostic laparoscopy 3 months postoperatively for a radiographic finding of suspected recurrence. At laparoscopy, the patch was intact, and no diaphragmatic hernia was noted.
Laparoscopic repair of congenital diaphragmatic defects using prosthetic material is possible although the operative time required is around 3.5 hours. Because of the brief postoperative course, the laparoscopic approach appears justified in the nonneonatal patients. Whether this approach is appropriate for repair of neonatal Bochdalek hernias remains unclear.
腹腔镜修复先天性膈疝的报道较少。此外，每份报告主要都是单个手术病例。在大多数报告中，未使用人工补片，即便使用，其本质上也是不可吸收的。这些病例报告大多仅记录了几个月的临床随访情况。
经机构审查委员会批准（编号01 - 12 - 115X），回顾了3例使用4层Surgisis软组织移植物（库克公司，印第安纳州布卢明顿）进行腹腔镜修复莫尔加尼孔和博赫dalek疝的患者的临床病程和结局，以确定这种方法是否合适。
2001年，2例年龄分别为9个月和14岁的患者接受了腹腔镜莫尔加尼孔修复术，1例5日龄婴儿接受了腹腔镜博赫dalek孔修复术，使用Surgisis软组织移植物作为补片来闭合膈肌缺损，因为一期修复时张力过大。在每例手术中，使用体内打结的间断丝线缝合将补片固定于缺损边缘。修复莫尔加尼孔缺损的平均手术时间为230分钟，术后1天和2天出院。对于博赫dalek孔修复术，手术时间为204分钟，患者在3周后出院。在任何手术过程中及术后均未发生并发症，但年龄最大的患者在术后3个月因影像学检查发现疑似复发而接受了诊断性腹腔镜检查。腹腔镜检查时，补片完整，未发现膈疝。
使用人工材料进行腹腔镜修复先天性膈肌缺损是可行的，尽管所需手术时间约为3.5小时。由于术后病程较短，腹腔镜方法对于非新生儿患者似乎是合理的。这种方法是否适用于新生儿博赫dalek疝的修复仍不清楚。
