Link: https://www.ncbi.nlm.nih.gov/pubmed/30300095

J Laparoendosc Adv Surg Tech A. 2018 Oct 6. doi: 10.1089/lap.2018.0025. [Epub ahead of print]
Thoracoscopic Treatment of Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children.
Yuan M1, Li F2, Xu C1, Fan X2, Xiang B1, Huang L1, Jiang X1, Yang G1.
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Abstract
PURPOSE:
Given that the application of thoracoscopic surgery to late-presenting congenital diaphragmatic hernia (CDH) in infants and children is controversial, we summarized our experiences with patients at two medical centers and aimed to discuss the safety and feasibility of thoracoscopic repair.

MATERIALS AND METHODS:
A retrospective review of late-presenting CDH cases involving patients who underwent thoracoscopic repair from October 2010 to June 2017 was performed. Data, including patients' demographic characteristics, manipulative details, and postoperative complications, were extracted and analyzed.

RESULTS:
A total of 59 cases were included in this study. Patients ranged in age from 2 months to 8 years (mean: 18 months). Twenty-five patients presented with shortness of breath and dyspnea. Furthermore, 34 cases were found occasionally. Forty-six left-sided hernias and 13 right-sided hernias were found. Operating time ranged from 30 to 100 minutes (mean: 55 minutes), and the amount of blood loss was 3-5 mL (mean: 3.8 mL). The size of the diaphragmatic defect ranged from 2 × 2 cm to 5 × 8 cm. The chest tubes were taken out within 24 hours. The average length of postoperative hospital stay was 5.2 ± 0.4 days (range: 4-6 days). The length of the follow-up period ranged from 3 months to 3 years (mean: 18 months), with no recurrences.

CONCLUSION:
Thoracoscopic repair of late-presenting CDH is a safe and efficacious technique. It can facilitate the procedure and decrease the recurrence rate by shifting the focus to operative details. The prognosis is excellent once the correct operative details are achieved.

KEYWORDS:
children; diaphragmatic hernia; late-presenting; surgery; thoracoscopy