Thoracoscopic surgery versus traditional open surgery for infants with congenital diaphragmatic eventration: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Shengliang , PAN Zhengxia , LI Yonggang , AN Yong , ZHAO Lu , JIN Xin , FU Jian ,  WU Chun

Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, P.R.China;

Corresponding author：

WU Chun, Email: wuchun0312@sina.com

Keywords：

Congenital diaphragmatic eventration; thoracoscopic diaphragm plication; traditional open surgery; infants; effects

DOI：

10.7507/1007-4848.202005019

Video：

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Objective To compare and analyze the treatment effect of thoracoscopic surgery and traditional open surgery on infants with congenital diaphragmatic eventration, and summarize the experience of thoracoscopic surgery in infants with congenital diaphragmatic eventration.Methods We retrospectively analyzed the clinical data of 105 children with congenital diaphragmatic eventration who received operation in the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2019. The patients were divided into an open group and a thoracoscopic group according to the operation methods. There were 41 patients in the thoracoscopic group, including 30 males and 11 females, with an average of 13.42±11.08 months (range: 1 d to 3 years). There were 64 patients in the open group, including 44 males and 20 females, with an average age of 8.21±9.33 months (range: 15.0 d to 1.6 years). The operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, hospital stay and other operation indexes as well as the mortality, recurrence rate and complication rate of the two groups were observed.Results The operation indexes such as operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, thoracic drainage time, CCU stay and hospital stay of the thoracoscopic group were better than those in the open group (P<0.05). There was no statistical difference between two groups in postoperative diaphgram muscles descent, postoperative feeding time or patients needing thoracic drainage (P>0.05). The incidence of postoperative complications in the thoracoscopic group (19.51%) was lower than that in the open group (23.44%, P>0.05), and the difference in mortality and recurrence rate between the two groups was not statistically significant (P>0.05).Conclusion Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with traditional open surgery, thoracoscopic diaphragmatic plication has the advantages of shorter operation time, less trauma, more rapid recovery and fewer complications, so it should be the first choice for children with congenital diaphragmatic eventration.

Citation： ZHAO Shengliang, PAN Zhengxia, LI Yonggang, AN Yong, ZHAO Lu, JIN Xin, FU Jian, WU Chun. Thoracoscopic surgery versus traditional open surgery for infants with congenital diaphragmatic eventration: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 709-713. doi: 10.7507/1007-4848.202005019 Copy

1.	Hines MH. Video-assisted diaphragm plication in children. Ann Thorac Surg, 2003, 76(1): 234-236.
2.	Pathak S, Page RD. Splenic injury following diaphragmatic plication: An avoidable life-threatening complication. Interact Cardiovasc Thorac Surg, 2009, 9(6): 1045-1046.
3.	Huang PC, Cheung YC, Lo YF, et al. A comparison of spring-loaded and vacuum-assisted techniques for stereotactic breast biopsy of impalpable microcalcification lesions: Experience at Chang Gung Memorial Hospital at Linkou. Chang Gung Med J, 2011, 34(1): 75-83.
4.	Cilley RE. Eventration of the diaphragm. In: Spitz. USA: CRC Press, 2013. 202-206.
5.	Martakis K, Körber F, Dübbers M. Eventration of the diaphragm in a 4-year-old child diagnosed with dextrocardia. Klin Padiatr, 2016, 228(4): 223-224.
6.	Stamenovic D. New technique of diaphragmatic plication by means of uniportal video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg, 2017, 25(1): 162-163.
7.	Mouroux J, Venissac N, Leo F, et al. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: A prospective study. Ann Thorac Surg, 2005, 79(1): 308-312.
8.	Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg, 2006, 81(5): 1853-1857.
9.	Hwang Z, Shin JS, Cho YH, et al. A simple technique for the thoracoscopic plication of the diaphragm. Chest, 2003, 124(1): 376-378.
10.	Moon SW, Wang YP, Kim YW, et al. Thoracoscopic plication of diaphragmatic eventration using endostaplers. Ann Thorac Surg, 2000, 70(1): 299-300.
11.	Parlak A, Gurpınar AN, Dogruyol H. Double purse-string suturing: An easy plication technique in thoracoscopic repair of diaphragmatic eventration. J Pediatr Surg, 2020, 55(5): 967-971.
12.	胡吉梦, 吴晔明, 王俊, 等. 腔镜手术治疗婴幼儿膈膨升 24 例临床分析. 中华小儿外科杂志, 2013, 34(11): 810-813.
13.	李朋飞, 刘江斌, 吕志宝. 胸腔镜下连续与间断折叠缝合膈肌治疗小儿先天性膈膨升的对比研究. 中华小儿外科杂志, 2017, 38(3): 197-200.
14.	Groth SS, Rueth NM, Kast T, et al. Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: An objective evaluation of short-term and midterm results. J Thorac Cardiovasc Surg, 2010, 139(6): 1452-1456.
15.	Phadnis J, Pilling JE, Evans TW, et al. Abdominal compartment syndrome: A rare complication of plication of the diaphragm. Ann Thorac Surg, 2006, 82(1): 334-336.
16.	Versteegh MI, Braun J, Voigt PG, et al. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg, 2007, 32(3): 449-456.

1. Hines MH. Video-assisted diaphragm plication in children. Ann Thorac Surg, 2003, 76(1): 234-236.
2. Pathak S, Page RD. Splenic injury following diaphragmatic plication: An avoidable life-threatening complication. Interact Cardiovasc Thorac Surg, 2009, 9(6): 1045-1046.
3. Huang PC, Cheung YC, Lo YF, et al. A comparison of spring-loaded and vacuum-assisted techniques for stereotactic breast biopsy of impalpable microcalcification lesions: Experience at Chang Gung Memorial Hospital at Linkou. Chang Gung Med J, 2011, 34(1): 75-83.
4. Cilley RE. Eventration of the diaphragm. In: Spitz. USA: CRC Press, 2013. 202-206.
5. Martakis K, Körber F, Dübbers M. Eventration of the diaphragm in a 4-year-old child diagnosed with dextrocardia. Klin Padiatr, 2016, 228(4): 223-224.
6. Stamenovic D. New technique of diaphragmatic plication by means of uniportal video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg, 2017, 25(1): 162-163.
7. Mouroux J, Venissac N, Leo F, et al. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: A prospective study. Ann Thorac Surg, 2005, 79(1): 308-312.
8. Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg, 2006, 81(5): 1853-1857.
9. Hwang Z, Shin JS, Cho YH, et al. A simple technique for the thoracoscopic plication of the diaphragm. Chest, 2003, 124(1): 376-378.
10. Moon SW, Wang YP, Kim YW, et al. Thoracoscopic plication of diaphragmatic eventration using endostaplers. Ann Thorac Surg, 2000, 70(1): 299-300.
11. Parlak A, Gurpınar AN, Dogruyol H. Double purse-string suturing: An easy plication technique in thoracoscopic repair of diaphragmatic eventration. J Pediatr Surg, 2020, 55(5): 967-971.
12. 胡吉梦, 吴晔明, 王俊, 等. 腔镜手术治疗婴幼儿膈膨升 24 例临床分析. 中华小儿外科杂志, 2013, 34(11): 810-813.
13. 李朋飞, 刘江斌, 吕志宝. 胸腔镜下连续与间断折叠缝合膈肌治疗小儿先天性膈膨升的对比研究. 中华小儿外科杂志, 2017, 38(3): 197-200.
14. Groth SS, Rueth NM, Kast T, et al. Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: An objective evaluation of short-term and midterm results. J Thorac Cardiovasc Surg, 2010, 139(6): 1452-1456.
15. Phadnis J, Pilling JE, Evans TW, et al. Abdominal compartment syndrome: A rare complication of plication of the diaphragm. Ann Thorac Surg, 2006, 82(1): 334-336.
16. Versteegh MI, Braun J, Voigt PG, et al. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg, 2007, 32(3): 449-456.

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Thoracoscopic surgery versus traditional open surgery for infants with congenital diaphragmatic eventration: A retrospective cohort study

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