Michel Armin-Johannes, Metzger Ulrike, Rice Steven Alan, Metzger Roman
Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria.
University Hospital for Children and Adolescents, Universitätsmedizin Rostock, 18057 Rostock, Germany.
Children (Basel). 2022 Jul 26;9(8):1116. doi: 10.3390/children9081116.
To describe a minimally invasive technique with primary closure and strong suture connection that is feasible in cases of larger, most common type B defects of congenital diaphragmatic hernia (CDH). The thoracoscopic approach (TA) is a favorable technique for the repair of CDH and is still evolving globally. A common issue is finding the optimal suture technique for secure closure in order to prevent recurrences. Whether a defect can be closed only by sutures or by using a patch depends on the size of CDH, the presence of a muscular rim along the inner thoracic surface and finally on the surgeon's experience. From a geometrical point of view, the challenge is to transform the circular defect into a line, without tension, with a strong compound and preferably without additional material. To address this, we apply a setting of the sutures in a "T-shape" and a way to lead the sutures around the rib bones in order to increase stability. This method allows for the primary closure of CDHs and also applies to larger defects. We present seven newborns with posterolateral CDH on the left side. The defects were solely repaired by TA and by the suturing technique described in detail.
描述一种具有一期缝合和牢固缝线连接的微创技术，该技术在先天性膈疝（CDH）较大且最常见的B型缺损病例中可行。胸腔镜手术（TA）是修复CDH的一种有利技术，并且在全球范围内仍在不断发展。一个常见的问题是找到用于安全闭合以防止复发的最佳缝合技术。缺损是仅能通过缝线闭合还是需要使用补片，取决于CDH的大小、胸内表面肌肉边缘的存在情况，最终还取决于外科医生的经验。从几何学角度来看，挑战在于将圆形缺损无张力地转化为一条线，形成牢固的组合，最好不使用额外材料。为解决这一问题，我们采用“T形”缝线设置以及一种将缝线绕过肋骨的方法来增加稳定性。该方法允许对CDH进行一期闭合，也适用于较大的缺损。我们展示了7例左侧后外侧CDH的新生儿。缺损仅通过TA和详细描述的缝合技术进行修复。
