Diaphragmatic eventration in children: Laparoscopy versus thoracoscopic plication

Go Miyano, Masaya Yamoto, Masakatsu Kaneshiro, Hiromu Miyake, Keiichi Morita, Hiroshi Nouso, Mariko Koyama, Manabu Okawada, Takashi Doi, Hiroyuki Koga, Koji Fukumoto, Geoffrey J. Lane, Atsuyuki Yamataka, Naoto Urushihara

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Aim: To determine the best way to perform diaphragmatic plication for diaphragmatic eventration (DE) using minimally invasive surgery. Materials and Methods: We conducted a retrospective review of pediatric cases of DE treated between 2007 and 2012. Thoracoscopic plication (TP) is performed using single-lung ventilation with three 5-mm ports; laparoscopic plication (LP) is performed using three or four 5-mm ports. The choice of technique was determined preferentially by the treating surgeon. Results: There were 20 subjects (13 treated by LP and 7 treated by TP). Etiology of DE was phrenic nerve injury (LP, n=11; TP, n=1) and muscular deficiency (LP, n=2; TP, n=6). Mean age (LP, 18 months; TP, 25 months) and weight (LP, 8.0?kg; TP, 9.7?kg) at surgery were not significantly different. Mean operating time was 155.6 minutes in LP and 167.0 minutes in TP (P=not significant). Mean intraoperative end-tidal CO2 was 41.9?mm Hg (range, 35-52?mm Hg) in LP and 36.9?mm Hg (range, 33-41?mm Hg) in TP (P=.01). Mean duration of postoperative ventilation was 1.2 days in LP and 1.3 days in TP (P=not significant). Mean time taken to recommence feeding postoperatively was 1.6 days in both groups (P=not significant). Complications were one conversion to thoracotomy in TP, 1 case of atelectasis in each group (P=not significant), and 6 cases of recurrence in LP versus none in TP (P=.04). Conclusions: Both TP and LP are beneficial for treating small children with DE. However, there is a higher incidence of recurrence after LP, and the role of TP in cardiac patients requiring subsequent surgery is debatable.

Original languageEnglish
Pages (from-to)331-334
Number of pages4
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume25
Issue number4
DOIs
Publication statusPublished - Apr 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Miyano, G., Yamoto, M., Kaneshiro, M., Miyake, H., Morita, K., Nouso, H., Koyama, M., Okawada, M., Doi, T., Koga, H., Fukumoto, K., Lane, G. J., Yamataka, A., & Urushihara, N. (2015). Diaphragmatic eventration in children: Laparoscopy versus thoracoscopic plication. Journal of Laparoendoscopic and Advanced Surgical Techniques, 25(4), 331-334. https://doi.org/10.1089/lap.2014.0237