Children (Basel)

. 2022 Jul 26;9(8):1116.

 doi: 10.3390/children9081116. https://pubmed.ncbi.nlm.nih.gov/35892619/

Thoracoscopic Guided Pericostal Sutures as a Solid Fixation for Primary Closure of Congenital Diaphragmatic Hernias

Armin-Johannes Michel ¹, Ulrike Metzger ¹, Steven Alan Rice ², Roman Metzger ¹

Affiliations expand

• PMID: 35892619
• PMCID: PMC9331833
• DOI: 10.3390/children9081116

Free PMC article

Abstract

Purpose: To describe a minimally invasive technique with primary closure and strong suture connection that is feasible in cases of larger, most common type B defects of congenital diaphragmatic hernia (CDH). Background: The thoracoscopic approach (TA) is a favorable technique for the repair of CDH and is still evolving globally. A common issue is finding the optimal suture technique for secure closure in order to prevent recurrences. Whether a defect can be closed only by sutures or by using a patch depends on the size of CDH, the presence of a muscular rim along the inner thoracic surface and finally on the surgeon’s experience. From a geometrical point of view, the challenge is to transform the circular defect into a line, without tension, with a strong compound and preferably without additional material. To address this, we apply a setting of the sutures in a “T-shape” and a way to lead the sutures around the rib bones in order to increase stability. This method allows for the primary closure of CDHs and also applies to larger defects. Cases: We present seven newborns with posterolateral CDH on the left side. The defects were solely repaired by TA and by the suturing technique described in detail.

Keywords: CDH; recurrence of CDH; repair of congenital diaphragmatic hernia; thoracoscopic pericostal suture technique.