Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.7)
Index Copernicus  – 161.11; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 8, August, p. 967–970

doi: 10.17219/acem/122396

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

The application of the percutaneous suturing technique in thoracoscopic repair of congenital diaphragmatic hernia

Bartosz Bogusz1,A,B,C,D,F, Adam Mol1,B,C,E, Oskar Zgraj2,A,D,E, Wojciech Górecki3,B,E,F

1 Department of Pediatric Surgery, University Children’s Hospital, Jagiellonian University Medical College, Kraków, Poland

2 Department of Pediatric Surgery, St. Luke Regional Hospital, Tarnów, Poland

3 Depertment of Pediatric Surgery, University Children’s Hospital, Jagiellonian University Medical College, Kraków, Poland

Abstract

Background. Thoracoscopic surgery of congenital diaphragmatic hernia (CDH) is connected with a higher incidence of recurrence than open repair is. This is usually caused by the dehiscence of sutures in the lateral part of the defect. This area is characterized by increased tension on proximate tissues and difficult thoracoscopic suturing. For more effective repair, the authors adopted a variant of percutaneous internal ring suturing (PIRS) technique.
Objectives. To present and evaluate the efficacy of the PIRS technique for the repair of CDH.
Material and Methods. The study is based on retrospective analysis of the medical data of patients with CDH treated in the Department of Pediatric Surgery of the Jagiellonian University Medical College (Kraków, Poland) from January 2013 to July 2019. The PIRS technique was applied when thoracoscopic repair under acceptable tension appeared impossible.
Results. Fifty-one patients were identified. Of these, 11 children died before surgery and 1 after, leaving 39 (76%) who were operated on and survived. Thoracoscopy was used in 27 cases (69%), with 3 conversions. The recurrence rate in patients who underwent thoracoscopic closure of the defect with intermittent sutures was 27% (3 out of 11 children), while in the group that underwent thoracoscopic repair with the additional use of percutaneous suturing, the recurrence rate was 6.25% (1 out of 16 patients). The follow-up periods ranged from 4 months to 6 years.
Conclusion. The applied PIRS technique permits safe and effective closure of intermediate-size diaphragmatic defects under acceptable tension. The method is feasible and can be listed among countermeasures against recurrence.

Key words

hernia, congenital, thoracoscopy, diaphragmatic, suturing

References (15)

  1. Zee DCVD, Bax NMA. Laparoscopic repair of congenital diaphrag­matic hernia in a 6-month-old child. Surg Endosc. 1995;9(9):1001–1003. doi:10.1007/bf00188460
  2. Becmeur F, Jamali R, Moog R, et al. Thoracoscopic treatment for delayed presentation of congenital diaphragmatic hernia in the infant. Surg Endosc. 2001;15(10):1163–1166. doi:10.1007/s004640090064
  3. Lansdale N, Alam S, Losty PD, Jesudason EC. Neonatal endosurgical congenital diaphragmatic hernia repair. Ann Surg. 2010;252(1):20–26. doi:10.1097/sla.0b013e3181dca0e8
  4. Gander JW, Fisher JC, Gross ER, et al. Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: A single institutional study. J Pediatr Surg. 2011;46(7):1303–1308. doi:10.1016/j.jpedsurg.2010.11.048
  5. Harting MT, Lally KP. The Congenital Diaphragmatic Hernia Study Group registry update. Semin Fetal Neonatal Med. 2014;19(6):370–375. doi:10.1016/j.siny.2014.09.004
  6. Putnam LR, Harting MT, Tsao K, et al. Congenital diaphragmatic hernia defect size and infant morbidity at discharge. Pediatrics. 2016;138(5):e20162043. doi:10.1542/peds.2016-2043
  7. Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W. Percutaneous internal ring suturing: A simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A. 2006;16(5):513–517. doi:10.1089/lap.2006.16.513
  8. Kim AC, Bryner BS, Akay B, Geiger JD, Hirschl RB, Mychaliska GB. Thoracoscopic repair of congenital diaphragmatic hernia in neonates: Lessons learned. J Laparoendosc Adv Surg Tech A. 2009;19(4):575–580. doi:10.1089/lap.2009.0129
  9. McHoney M, Giacomello L, Nah SA, et al. Thoracoscopic repair of congenital diaphragmatic hernia: Intraoperative ventilation and recurrence. J Pediatr Surg. 2010;45(2):355–359. doi:10.1016/j.jpedsurg.2009.10.072
  10. Gourlay DM, Cassidy LD, Sato TT, Lal DR, Arca MJ. Beyond feasibility: A comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias. J Pediatr Surg. 2009;44(9):1702–1707. doi:10.1016/j.jpedsurg.2008.11.030
  11. Lao OB, Crouthamel MR, Goldin AB, Sawin RS, Waldhausen JH, Kim SS. Thoracoscopic repair of congenital diaphragmatic hernia in infancy. J Laparoendosc Adv Surg Tech A. 2010;20(3):271–276. doi:10.1089/lap.2009.0150
  12. Chen B, Wang Q, Li B, Wang B. Thoracoscopic repair of diaphragmatic hernia in infants: A new modification of the technique. Eur J Pediatr Surg. 2015;26(06):519–523. doi:10.1055/s-0035-1568996
  13. Boo Y, Rohleder S, Muensterer O. A novel technique of posterolateral suturing in thoracoscopic diaphragmatic hernia repair. Eur J Pediatr Surg Rep. 2017;05(1):e26–e28. doi:10.1055/s-0037-1604049
  14. Inoue M, Uchida K, Otake K, et al. Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy. Surg Endosc. 2015;30(3):1014–1019. doi:10.1007/s00464-015-4287-6
  15. Jancelewicz T, Langer JC, Chiang M, Bonnard A, Zamakhshary M, Chiu PP. Thoracoscopic repair of neonatal congenital diaphrag­matic hernia (CDH): Outcomes after a systematic quality improvement process. J Pediatr Surg. 2013;48(2):321–325. doi:10.1016/j.jpedsurg. 2012.11.012
© Wroclaw Medical University