Pediatric Surgery Department/Section - Minimally Invasive Surgery Unit, Cairo University Specialised Pediatric Hospital (CUSPH), Faculty of Medicine (Kasr Alainy), Cairo University, Cairo, Egypt.
Fayoum University, El Fayoum, Egypt.
Surg Endosc. 2021 Jul;35(7):3279-3284. doi: 10.1007/s00464-020-07764-5. Epub 2020 Jul 2.
Several measures were implemented among authors striving to tail off recurrence rates of thoracoscopic congenital diaphragmatic hernia repair. In the presented study, we extended the use of rib-anchoring stitches to reorient the diaphragmatic muscle leaflets in the types B&C diaphragmatic hernias, to achieve tension dispersal at primary thoracoscopic repair.
Included in this study were early and late-onset lateral congenital diaphragmatic hernia patients, who had been operated upon in the years 2012 through 2018. A preliminary stitch was taken between posterior muscle edge and rib cage to reorient the diaphragmatic defect into a reversed C-shaped line. The lateral portion was closed by additional rib-anchoring stitches, while the medial one necessitated muscle to muscle stitches. Primary outcome being validated was the recurrence rate within a year post repair.
In the 7-year inclusion period, 36 congenital diaphragmatic hernia cases were managed using the described approach. The repair was accomplished thoracoscopically in all but two cases, who were excluded from the study. Mean operative time was 76 min. No pledgets or synthetic patches were applied. Mean length of hospital stay was 7.6 days. Early postoperative course was uneventful in all but four cases; two ventilatory barotrauma and two mortalities. After a mean follow-up period of 29 months, five recurrences were reported (16%). Ipsilateral chest wall deformity was noticed in one case 3 years post repair.
In the presented study, authors adopted thoracoscopic reorientation of diaphragmatic muscle leaflets in lateral congenital diaphragmatic hernia cases to achieve tension dispersal at primary repair. Short and mid-term results supported the efficacy and reproducibility of the described approach. However, long-term comparative studies seemed a necessity to validate this outcome.
为了降低胸腔镜先天性膈疝修补术后复发率，作者采取了多种措施。在本研究中，我们将肋骨锚固缝线的使用扩展到 B&C 型膈疝，以在初次胸腔镜修复时实现张力分散。
本研究纳入了 2012 年至 2018 年期间接受手术治疗的早发性和迟发性外侧先天性膈疝患者。在初步缝线之间，在后肌缘和肋骨笼之间进行操作，以将膈疝缺陷重新定向为反向 C 形线。外侧部分通过附加的肋骨锚固缝线关闭，而内侧部分需要肌肉到肌肉缝线。验证的主要结果是修复后一年内的复发率。
在 7 年的纳入期内，使用描述的方法管理了 36 例先天性膈疝病例。除了 2 例因无法进行研究而被排除的病例外，所有病例均通过胸腔镜完成了修复。平均手术时间为 76 分钟。未使用垫或合成补片。平均住院时间为 7.6 天。除了 4 例外，所有患者的术后早期都没有发生意外；2 例呼吸性气压伤和 2 例死亡。在平均 29 个月的随访期后，报告了 5 例复发（16%）。在修复后 3 年，发现 1 例出现同侧胸壁畸形。
在本研究中，作者采用胸腔镜方法重新定向外侧先天性膈疝的膈肌叶片，以在初次修复时实现张力分散。短期和中期结果支持描述方法的疗效和可重复性。然而，似乎需要进行长期的比较研究来验证这一结果。
