Attempt to shift from traditional to minimal invasive treatment of congenital diaphragmatic hernia at a low volume center

Abstract

Background: Congenital diaphragmatic hernia (CDH) remains a significant cause of neonatal morbidity and mortality. During the last 10-years, the progress on minimal invasive surgical techniques, has stimulated many Pediatric Surgical centers to switch from traditional open surgery to thoracoscopic or laparoscopic repair. Methods: We report our experience to convert treatment of CDH from traditional to minimal invasive. We have reviewed the charts of 10 neonates with diagnosed CDH over the period 2016–2021. On all of them, we collected pre, intra and post-operative information. Results: Interestingly, none of neonates had prenatal diagnosis of CDH but this didn't impact on morbidity or mortality. None of them was extremely preterm or had major cardiac anomalies. Thoracoscopic or laparoscopic approach was attempted in 3 cases but only in one patient was successful. In the other 2 neonates we had to switch to open surgery because of anatomical conditions. Conclusions: In our opinion, the learning curve needed to achieve minimal invasive treatment of CDH is associated with a high conversion rate often, as a consequence of anatomical conditions.

Keywords

• Congenital diaphragmatic hernia
• Neonates
• Thoracoscopy
• Outcome