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Introduction <p>Thoracoscopic repair of congenital diaphragmatic hernia remains a challenging procedure, particularly in cases involving large defects. Increasingly, surgeons prefer thoracoscopic mesh repair for wide-defect congenital diaphragmatic hernias (CDH) because it is associated with lower morbidity and improved outcomes. This study evaluates the outcomes of thoracoscopic mesh repair in this patient population.</p> Methods <p>This single-center retrospective review examined thoracoscopic and open congenital diaphragmatic hernia (CDH) mesh repairs performed between June 2017 and July 2024. During this period, 51 patients with diaphragmatic hernias were managed. Four patients with severe associated malformations died before surgery, while one patient with a hiatal hernia, nine with Morgagni hernias managed laparoscopically, seven who underwent primary laparotomy, one who had a primary thoracotomy, and one 8 year-old girl who underwent primary laparoscopy were excluded from the analysis. All neonates with CDH were electively ventilated. Patients were positioned laterally for 4–6&#xa0;h prior to surgery. Those who tolerated the lateral position and maintained adequate oxygen saturation were considered candidates for thoracoscopic repair. Unstable patients or those unable to tolerate lateral positioning underwent laparotomy or thoracotomy. Primary repair was performed using interrupted Ethibond sutures. For patch repairs, a DUO composite GORE-TEX mesh was used and secured with interrupted 3 − 0 or 2 − 0 Ethibond sutures. Outcome measures included operative time, intraoperative complications, length of hospital stay, recurrence, need for re-operation, and postoperative complications.</p> Results <p>26 patients with CDH met the inclusion criteria and were reviewed. The cohort included 19 males and 7 females, with successful thoracoscopic repairs achieved in 22 cases. Four cases required conversion: two to thoracotomy and two to laparotomy. All converted cases ultimately required mesh repair. There were three postoperative deaths, all occurring in patients who underwent mesh repair; these were primarily attributable to severe comorbidities. Redo surgery was required in 5 of the 26 patients. Both the average operative time and the length of hospital stay were significantly shorter in patients who underwent thoracoscopic repair without mesh.</p> Conclusions <p>Although the sample size is small, our findings indicate that thoracoscopic mesh repair is a safe technique with outcomes comparable to those achieved with open surgery. The observed complications appear to be primarily related to patient comorbidities and the size of the diaphragmatic defect.</p>

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Thoracoscopic mesh repair for congenital diaphragmatic hernia: is it a safe option?

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Iftikhar Ahmad Jan,
  • Faisal M Al-Zidgali,
  • Tamer Hamed Ibrahim,
  • Humaid AlZaabi,
  • Hiba Mohamed Ahmed,
  • Mohammad Ilyas Bader,
  • Zahid Latif Saqi,
  • Deepak Kishore Kaltari

摘要

Introduction

Thoracoscopic repair of congenital diaphragmatic hernia remains a challenging procedure, particularly in cases involving large defects. Increasingly, surgeons prefer thoracoscopic mesh repair for wide-defect congenital diaphragmatic hernias (CDH) because it is associated with lower morbidity and improved outcomes. This study evaluates the outcomes of thoracoscopic mesh repair in this patient population.

Methods

This single-center retrospective review examined thoracoscopic and open congenital diaphragmatic hernia (CDH) mesh repairs performed between June 2017 and July 2024. During this period, 51 patients with diaphragmatic hernias were managed. Four patients with severe associated malformations died before surgery, while one patient with a hiatal hernia, nine with Morgagni hernias managed laparoscopically, seven who underwent primary laparotomy, one who had a primary thoracotomy, and one 8 year-old girl who underwent primary laparoscopy were excluded from the analysis. All neonates with CDH were electively ventilated. Patients were positioned laterally for 4–6 h prior to surgery. Those who tolerated the lateral position and maintained adequate oxygen saturation were considered candidates for thoracoscopic repair. Unstable patients or those unable to tolerate lateral positioning underwent laparotomy or thoracotomy. Primary repair was performed using interrupted Ethibond sutures. For patch repairs, a DUO composite GORE-TEX mesh was used and secured with interrupted 3 − 0 or 2 − 0 Ethibond sutures. Outcome measures included operative time, intraoperative complications, length of hospital stay, recurrence, need for re-operation, and postoperative complications.

Results

26 patients with CDH met the inclusion criteria and were reviewed. The cohort included 19 males and 7 females, with successful thoracoscopic repairs achieved in 22 cases. Four cases required conversion: two to thoracotomy and two to laparotomy. All converted cases ultimately required mesh repair. There were three postoperative deaths, all occurring in patients who underwent mesh repair; these were primarily attributable to severe comorbidities. Redo surgery was required in 5 of the 26 patients. Both the average operative time and the length of hospital stay were significantly shorter in patients who underwent thoracoscopic repair without mesh.

Conclusions

Although the sample size is small, our findings indicate that thoracoscopic mesh repair is a safe technique with outcomes comparable to those achieved with open surgery. The observed complications appear to be primarily related to patient comorbidities and the size of the diaphragmatic defect.