Minimally invasive repair of late presenting congenital diaphragmatic hernia in children

ABSTRACT

Patients with congenital diaphragmatic hernia usually present in the immediate neonatal period with respiratory distress. Delayed presentations of congenital hernia occurring outside of the neonatal period have been reported for all ages. Classically, repair of the hernial defect involves a transverse subcostal laparotomy in the pediatric age group. The first report describing a laparoscopic repair of a congenital diaphragmatic hernia in a 6-month-old infant was published in 1995. Since then there is growing experience with a minimal access approach to these defects. During the past 4 years, minimally invasive repair was used to treat 18 patients with delayed presentation of congenital diaphragmatic hernias at Cairo University specialized pediatric hospital. All defects, but one were directly sutured without the use of a mesh. All patients were healthy without signs of recurrence observed at chest X-ray after a follow-up of 7 to 22 months. Minimally invasive approach for the repair of delayed-presentation congenital diaphragmatic hernia is feasible. Although experience is still limited, the results of this study demonstrate that under specific conditions the laparoscopic approach can be an effective and more advantageous alternative to laparotomy for diaphragmatic congenital diseases in a pediatric population. Benefits include that it provides an excellent view of the surgical field, ease of execution, minimal surgical trauma, excellent cosmetic results, rapid recovery, and shorter hospitalization