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Thoracoscopic versus open repair of CDH in cardiovascular stable neonates

BACKGROUND: Thoracoscopic surgery is an increasingly popular surgical technique to repair congenital diaphragmatic hernia (CDH). However, acidosis during surgery and the higher recurrence rate are considerable risk factors. The aim of this retrospective study is to compare the outcome of open versus...

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Autores principales: Costerus, Sophie, Zahn, Katrin, van de Ven, Kees, Vlot, John, Wessel, Lucas, Wijnen, Rene
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912591/
https://www.ncbi.nlm.nih.gov/pubmed/26490767
http://dx.doi.org/10.1007/s00464-015-4560-8
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author Costerus, Sophie
Zahn, Katrin
van de Ven, Kees
Vlot, John
Wessel, Lucas
Wijnen, Rene
author_facet Costerus, Sophie
Zahn, Katrin
van de Ven, Kees
Vlot, John
Wessel, Lucas
Wijnen, Rene
author_sort Costerus, Sophie
collection PubMed
description BACKGROUND: Thoracoscopic surgery is an increasingly popular surgical technique to repair congenital diaphragmatic hernia (CDH). However, acidosis during surgery and the higher recurrence rate are considerable risk factors. The aim of this retrospective study is to compare the outcome of open versus thoracoscopic repair of the diaphragm in neonates with CDH with the same degree of cardiovascular and pulmonary illness who meet the criteria for thoracoscopic repair. METHODS: Retrospective analysis of all patients of two large national reference centers for CDH born in the years 2008 through 2012, and meeting the criteria for surgical repair on cardiopulmonary and physiological criteria according to the CDH EURO consortium consensus and meeting the criteria for thoracoscopic repair according to the review by Vijfhuize et al. The surgical technical aspects were comparable in both centers. RESULTS: 108 patients were included, of whom 75 underwent thoracoscopic repair and 34 underwent open repair. The gestational age and lung-to-head ratio were significantly lower and stay on the ICU significantly longer in the open-repair group. The operation time was longer (178 vs. 150 min, p = .012) and the recurrence rate higher (18.9 vs. 5.9 %, p = .036) in the thoracoscopic-repair group. The arterial pH, pO(2), pCO(2) and base excess before and after thoracoscopic repair were all significantly different. CONCLUSION: After critical selection for thoracoscopic repair of left-sided CDH based on the patient’s preoperative condition, the outcomes of open repair were almost identical to those of thoracoscopic repair. A notable exception is the recurrence rate, which was significantly higher in the thoracoscopic-repair group. For the time being, thoracoscopic primary closure seems a safe and effective procedure, but efficacy of thoracoscopic patch repair has not been established.
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spelling pubmed-49125912016-07-06 Thoracoscopic versus open repair of CDH in cardiovascular stable neonates Costerus, Sophie Zahn, Katrin van de Ven, Kees Vlot, John Wessel, Lucas Wijnen, Rene Surg Endosc Article BACKGROUND: Thoracoscopic surgery is an increasingly popular surgical technique to repair congenital diaphragmatic hernia (CDH). However, acidosis during surgery and the higher recurrence rate are considerable risk factors. The aim of this retrospective study is to compare the outcome of open versus thoracoscopic repair of the diaphragm in neonates with CDH with the same degree of cardiovascular and pulmonary illness who meet the criteria for thoracoscopic repair. METHODS: Retrospective analysis of all patients of two large national reference centers for CDH born in the years 2008 through 2012, and meeting the criteria for surgical repair on cardiopulmonary and physiological criteria according to the CDH EURO consortium consensus and meeting the criteria for thoracoscopic repair according to the review by Vijfhuize et al. The surgical technical aspects were comparable in both centers. RESULTS: 108 patients were included, of whom 75 underwent thoracoscopic repair and 34 underwent open repair. The gestational age and lung-to-head ratio were significantly lower and stay on the ICU significantly longer in the open-repair group. The operation time was longer (178 vs. 150 min, p = .012) and the recurrence rate higher (18.9 vs. 5.9 %, p = .036) in the thoracoscopic-repair group. The arterial pH, pO(2), pCO(2) and base excess before and after thoracoscopic repair were all significantly different. CONCLUSION: After critical selection for thoracoscopic repair of left-sided CDH based on the patient’s preoperative condition, the outcomes of open repair were almost identical to those of thoracoscopic repair. A notable exception is the recurrence rate, which was significantly higher in the thoracoscopic-repair group. For the time being, thoracoscopic primary closure seems a safe and effective procedure, but efficacy of thoracoscopic patch repair has not been established. Springer US 2015-10-21 2016 /pmc/articles/PMC4912591/ /pubmed/26490767 http://dx.doi.org/10.1007/s00464-015-4560-8 Text en © The Author(s) 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Article
Costerus, Sophie
Zahn, Katrin
van de Ven, Kees
Vlot, John
Wessel, Lucas
Wijnen, Rene
Thoracoscopic versus open repair of CDH in cardiovascular stable neonates
title Thoracoscopic versus open repair of CDH in cardiovascular stable neonates
title_full Thoracoscopic versus open repair of CDH in cardiovascular stable neonates
title_fullStr Thoracoscopic versus open repair of CDH in cardiovascular stable neonates
title_full_unstemmed Thoracoscopic versus open repair of CDH in cardiovascular stable neonates
title_short Thoracoscopic versus open repair of CDH in cardiovascular stable neonates
title_sort thoracoscopic versus open repair of cdh in cardiovascular stable neonates
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912591/
https://www.ncbi.nlm.nih.gov/pubmed/26490767
http://dx.doi.org/10.1007/s00464-015-4560-8
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