| BackgroundCongenital diaphragmatic hernia (CDH) continues to be a critical problem in neonatal surgery. The cause of CDH is unknown. Surgery is the main treatment for CDH. The surgical models of congenital diaphragmatic hernia including open and MIS approach. The arrival of small videoscopic instrumentation allowed the management of neonatal CDH by pediatric surgeons trained to perform MIS procedures. The MIS approach can lead to less postoperative morbidity, faster recovery, and shorter hospitalization, but it also can precipitate complications. Because of the short time of laparoscopy applied in CDH, the prognosis needs distant observation. Whether the indication, security and efficacy of laparoscopy in CDH needs more studies.ObjectiveThe aim of this study was to evaluate outcome of neonatal with congenital diaphragmatic hernia undergoing open versus minimally invasive surgery.Methods59neonatal congenital diaphragmatic hernia cases collected from June.2002to February.2014. These patients were divided into2groups, minimally invasive surgery group and open-group.19cases were repaired by minimally invasive surgery,10cases were repaired by thoracoscopy,9cases were repaired by laparoscopy.40cases were treated by open surgery. Clinical data including preoperative data, treatments, postoperative management were retrospectively reviewed. The comparison of clinical data was made between minimally invasive surgery and open-group. Outcome and recurrence were evaluated.According to the operation period,19patients underwent MIS are divided into two groups:11patients operated in the last five years surgery group(2009.3-2014.2) and8patients operated in previous surgery group(2002.6-2009.2), they are compared in the aspects the above-mentioned.Results1. The difference between the groups is not statistically significant at the aspects of the patients’age[(3.4±0.2)d vs.(4.1±0.5)d,P=0.654],body weight[(3.3±0.3)kg vs.(3.5±0.2)kg, P=0.815]2.Compared with the patients in open-group, the patients in MIS group had a longer operative duration(115.6±31.2min vs92.5±19.4min, P=0.023), less blood loss(1.53±0.22ml vs6.59±0,94ml, P=0.044), less antibiotics consumption time(2.8±0.2d vs4.8±0.3d, P=0.042), shorter the in-hospital time[(14.2±2.7)d vs.(21.5±3.5)d, P=0.042], less postoperative duration of mechanical ventilation time[(1.8±0.2)d vs.(5.1±0.9)d, P=0.034].3.The difference between the groups is not statistically significant in the followings: survival rate (94.7%vs95%), recurrence rate(15.8%vs5%), postoperative PCO2with in24h[(47.8±1.8mmHg)vs(48.6±1.5mmHg)], the incidence of postoperative hydrothorax(10.5%vs7,5%).4.Compared with the patients underwent MIS in previous surgery group, the last five years surgery group had a shoter operative duration(103.2±21.4min vs121.8±35.3min), shorter the in-hospital time(13.8±2.1d vs15.2±2.7d), recurrence rate (9%vs25%), but the above indicators between the two groups had no significant statistic differences(P<0.05).Conclusion1.The indication of minimally invasive surgery group in Congenital diaphragmatic hernia is similar to open surgery group. It can provide the basis of random cohort study of minimally invasive surgery and open surgery in CDH.2. To compare with open surgery, minimally invasive surgery repair have no increase in the incidence rate of operation-related complication. And two groups’ survival rate is equated. We consider that the minimally invasive surgery repair is safe and valid.3.Shorter operative duration and less blood loss can be found in minimally invasive surgery with the advance of operative technology. It indicates that enhancing minimally invasive surgery training can raise the operative quality and is favourable to the applying of minimally invasive surgery in Congenital diaphragmatic hernia. |
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