Video-assisted Thoracic Surgery for Congenital Diaphragmatic Hernia Compared With Conventional Open Surgery in Infants

Abstract

\n BackgroundThis study aimed to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of congenital diaphragmatic hernia (CDH) in a larger series compared with conventional open surgery. Additionally, we summarized the experience of thoracoscopic surgery in the treatment of CDH in infants.MethodsWe retrospectively analysed the clinical data of 109 children with CDH who underwent surgical treatment at the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2019. According to the surgical method, the children were divided into an open group (62 cases) and a thoracoscopy group (47 cases). We compared the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay, postoperative CCU admission time and other surgical indicators as well as the recurrence rate, mortality rate and complication rate of the two groups of children.ResultsThe index data on the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05). Compared with the number of incision infections, pulmonary infections, atelectasis, pleural effusion and chylothorax between the two groups, the number of children in the open group was greater than that in the thoracoscopy group, and the total postoperative complication rate (51.61%) was higher than that in the thoracoscopy group (44.68%). The recurrence rate of the thoracoscopy group (8.51%) was higher than that of the open group (3.23%). In the open group, 2 patients died of respiratory distress after surgery, and no patients died in the thoracoscopy group.ConclusionsThoracoscopic surgery and open surgery can effectively treat CDH. Open surgery has advantages in patients with unstable haemodynamics, large diaphragm defects and abdominal malformations. Compared with conventional open surgery, thoracoscopy has the advantages of shorter operation time, less trauma, faster recovery and fewer complications, but there is a risk of recurrence. The choice of surgical method should be determined by the characteristics of diaphragmatic lesions and the experience of the clinician.