Department of Paediatric Surgery | Cairo University Specialized Paediatric Hospital (CUSPH) & Cairo University Children's Hospital (CUCH) (email)
Background/aim: This type of diaphragmatic hernia describes an anterolateral defect in the diaphragm. The defect boundaries can be clearly defined thoracoscopically as the anterolateral edge: the costal margin and the posteromedial ‘‘C-shaped’’ muscle edge. We describe a simple tension free thoracoscpic technique for its repair.
Methods: Using three 5-mm instruments, several rib anchoring stitches, the C-shaped diaphragmatic defect is reoriented into a sickle shaped repair. This reorientation creates two limbs: one limb is the lateral, between the costal margin and the muscle and a vertical limb where the muscle is sutured to itself. In a five years period 31 patients were treated using this technique.
Results: Their age ranged from 8 months to 3 years. The side of anterolateral diaphragmatic hernia was on left in 26 and right in five cases the cases. The mean operative time was 105min and the mean follow-up time was 29 months. There was no procedure-related major complication or mortality. The repair was completed in all case thoracoscopically using 2/0 Ethibond stitches. Prolonged ileus was noticed in 3 patients. Seven children suffered from mild reflux symptoms that persisted for 6 to 9 months. Reflux symptoms in 7 patients. Buried stitches caused discomfort in two patients. Chest deformity was reported in one patient. No recurrences was reported in any of the patients.
Conclusion: Thoracoscopic revered orientation of the anterolateral diaphragmatic defect offers a tension free repair. An added benefit is the elimination of use of synthetic material.
Annals of Pediatric Surgery 2015, 11:65–112
Annals of Pediatric Surgery 2015, 11:65–112