J Pediatr Surg

 2020 Jan 8[Online ahead of print] https://pubmed.ncbi.nlm.nih.gov/32005504-early-surgical-complications-after-congenital-diaphragmatic-hernia-repair-by-thoracotomy-vs-laparotomy-a-bicentric-comparison/

Early Surgical Complications After Congenital Diaphragmatic Hernia Repair by Thoracotomy vs. Laparotomy: A Bicentric Comparison

Felix De Bie ¹, Etienne Suply ², Tom Verbelen ³, Stijn Vanstraelen ⁴, Anne Debeer ⁵, Kate Cross ², Joe Curry ², Willy Coosemans ⁴, Jan Deprest ⁶, Paolo De Coppi ⁷, Herbert Decaluwé ⁴Affiliations expand

• PMID: 32005504
• DOI: 10.1016/j.jpedsurg.2019.12.020

Abstract

Purpose: The surgical strategy for congenital diaphragmatic hernia (CDH) repair remains debated and mainly depends on the training and preference of the surgeon. Our aim was to evaluate the occurrence and nature of surgical reinterventions within the first year of life, following repair through thoracotomy as compared to laparotomy.

Methods: This is a retrospective bi-centric cohort study comparing postero-lateral thoracotomy (n = 55) versus subcostal laparotomy (n = 62) for CDH repair (IRB: MP001882). We included neonates with isolated, left-sided, Bochdalek-type CDH who were operated on between 2000 and 2017, and had a minimum follow-up of 1 year. Excluded were patients treated prenatally and/or had extra-corporeal membrane oxygenation. Outcomes were occurrence and nature of surgical reinterventions and mortality by 1 year of life.

Results: Both groups had comparable neonatal severity risk profiles. The overall surgical reintervention rate by 1 year of age was higher in the thoracotomy group (29.1% vs. 6.5%; p = 0.001), mainly because of a higher prevalence of acute bowel complications (18.1% vs. 3.2%; p = 0.012) requiring surgery, such as perforation, obstruction and volvulus. At 1 year of follow-up, groups were similar in terms of recurrence (5.5% vs. 1.6%; p = 0.341), surgical interventions related to severe gastroesophageal reflux disease (3.6% vs. 1.6%; p = 0.600) and mortality (5.5% vs. 6.6%; p = 1.000).

Conclusion: Postnatal CDH repair through thoracotomy was associated with a higher rate of surgical reinterventions within the first year of life, especially for severe acute gastro-intestinal complications. There seemed to be no difference in recurrence and mortality rate.

Type of study: Retrospective Comparative Cohort Study.

Level of evidence: Level III.

Keywords: Complications; Congenital diaphragmatic hernia; Laparotomy; Open repair; Thoracotomy.

Copyright © 2019. Published by Elsevier Inc.