Diaphragmatic eventration in children: laparoscopy versus thoracoscopic plication.

Abstract

AIM:

To determine the best way to perform diaphragmatic plication for diaphragmatic eventration (DE) using minimally invasive surgery.

MATERIALS AND METHODS:

We conducted a retrospective review of pediatric cases of DE treated between 2007 and 2012. Thoracoscopic plication (TP) is performed using single-lung ventilation with three 5-mm ports; laparoscopic plication (LP) is performed using three or four 5-mm ports. The choice of technique was determined preferentially by the treating surgeon.

RESULTS:

There were 20 subjects (13 treated by LP and 7 treated by TP). Etiology of DE was phrenic nerve injury (LP, n=11; TP, n=1) and muscular deficiency (LP, n=2; TP, n=6). Mean age (LP, 18 months; TP, 25 months) and weight (LP, 8.0 kg; TP, 9.7 kg) at surgery were not significantly different. Mean operating time was 155.6 minutes in LP and 167.0 minutes in TP (P=not significant). Mean intraoperative end-tidal CO2 was 41.9 mm Hg (range, 35-52 mm Hg) in LP and 36.9 mm Hg (range, 33-41 mm Hg) in TP (P=.01). Mean duration of postoperative ventilation was 1.2 days in LP and 1.3 days in TP (P=not significant). Mean time taken to recommence feeding postoperatively was 1.6 days in both groups (P=not significant). Complications were one conversion to thoracotomy in TP, 1 case of atelectasis in each group (P=not significant), and 6 cases of recurrence in LP versus none in TP (P=.04).

CONCLUSIONS:

Both TP and LP are beneficial for treating small children with DE. However, there is a higher incidence of recurrence after LP, and the role of TP in cardiac patients requiring subsequent surgery is debatable.

• Authors: Go Miyano, Masaya Yamoto, Masakatsu Kaneshiro, Hiromu Miyake, Keiichi Morita, Hiroshi Nouso, Mariko Koyama, Manabu Okawada, Takashi Doi, Hiroyuki Koga, Koji Fukumoto, Geoffrey J Lane, Atsuyuki Yamataka, Naoto Urushihara
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 25 Issue 4 Pg. 331-4 (Apr 2015) ISSN: 1557-9034 [Electronic] United States
• PMID: 25760817 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Topics

• Child
• Child, Preschool
• Diaphragmatic Eventration (surgery)
• Female
• Humans
• Infant
• Infant, Newborn
• Laparoscopy (methods)
• Male
• Retrospective Studies
• Thoracoscopy (methods)
• Treatment Outcome