J Laparoendosc Adv Surg Tech A

. 2021 Sep 6. doi: 10.1089/lap.2021.0210. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/34491842/

Thoracoscopic Repair of Neonatal Congenital Diaphragmatic Hernia: Minimizing Open Repair in a Low-Income Country

Mostafa Kotb ¹, Sameh Shehata ¹, Ahmed Khairi ¹, Sherif Mohamed Shehata ², Tamer Ghoneim ³, Aliaa Rabie ³Affiliations expand

• PMID: 34491842
• DOI: 10.1089/lap.2021.0210

Abstract

Aim: To assess the severity of persistent pulmonary hypertension (PPH) in congenital diaphragmatic hernia (CDH) neonates solely using oxygenation index (OI). Study Design: A prospective study was carried out from April 2016 to March 2019, where all confirmed CDH neonates were evaluated for the possibility repair through thoracoscopic approach. The severity of PPH was assessed using OI. It is calculated using the equation: mean airway pressure (MAP) × FiO₂ × 100 ÷ PaO₂. Neonates having OI <5 were considered to have a mild degree of pulmonary hypertension; hence, thoracoscopic repair was offered for them. Results: Thirty-nine CDH cases met the selection criteria; therefore, they underwent thoracoscopic repair. Primary diaphragmatic repair was successfully accomplished thoracoscopically in all neonates without any perioperative complications. Conversion from thoracoscopy to open method occurred in five cases. The causes were due to difficulties encountered during repair and none was due to a pure anesthetic problem or general deterioration during thoracoscopy. Recurrence had occurred in two cases only. Conclusion: OI is a reliable subjective parameter that could be used as an adjuvant to the usually used cardiovascular and pulmonary parameters for thoracoscopic repair decision. With increasing surgical experience, a wider range of neonates may be considered for thoracoscopic CDH repair.

Keywords: congenital diaphragmatic hernia; oxygenation index; thoracoscopic repair.