Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita-Shi, Osaka, Japan.
Surg Today. 2023 May;53(5):640-646. doi: 10.1007/s00595-022-02609-1. Epub 2022 Nov 4.
Thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) is associated with a higher recurrence rate than the conventional open method. We evaluated the effectiveness of our strategy for quality improvement, named "tension-free TR of CDH".
The subjects of this retrospective analysis were 11 consecutive patients with CDH who underwent TR at our hospital between 2017 and 2021. Tension-free TR of CDH included the proactive use of an oversized patch for dome-shaped reconstruction and gapless suturing. We developed a percutaneous extracorporeal closure technique for secure suturing using a commercially available needle.
Patch repair was performed in 8 (73%) patients and none required conversion to open surgery because of technical difficulties. Recurrence developed in one patient (9%), who underwent successful reoperation via TR. All patients had an uneventful postoperative course.
Tension-free TR combined with extracorporeal closure could reduce the difficulty of suturing and the risk of recurrence of CDH.
与传统的开放式方法相比，胸腔镜修复（TR）先天性膈疝（CDH）与更高的复发率相关。我们评估了我们的“CDH 无张力 TR”质量改进策略的有效性。
本回顾性分析的对象是 2017 年至 2021 年在我院接受 TR 的 11 例连续 CDH 患者。CDH 的无张力 TR 包括主动使用过大的补丁进行穹顶重建和无间隙缝合。我们开发了一种经皮体外闭合技术，使用市售的针进行安全缝合。
8 例（73%）患者进行了补丁修复，由于技术困难，无一例需要转为开放式手术。1 例（9%）患者复发，通过 TR 再次成功手术。所有患者术后均无并发症。
无张力 TR 结合体外闭合可降低 CDH 缝合难度和复发风险。
