Document Detail


Minimally invasive repair of congenital diaphragmatic hernia.
MedLine Citation:
PMID:  21683215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry.
METHODS: Prospectively collected data from infants with CDH were analyzed from the Congenital Diaphragmatic Hernia Registry from January 1995 to January 2010. Recurrent hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques.
RESULTS: Five thousand four hundred eighty infants with CDH were identified, of which 4516 (82.4%) were repaired. Operative data were available in 4390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with 12 reported recurrences (7.9%) compared with 114 for open techniques (2.7%, P < .05). Minimally invasive surgery demonstrated a significant increased odds for recurrence (odds ratio, 3.59; 95% confidence interval, 1.92-6.71) after adjusting for gestational age, birth weight, patch repair, and extracorporeal membrane oxygenation.
CONCLUSION: Minimally invasive techniques appear to have a significant higher recurrent hernia rate, with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regard to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization.
Authors:
KuoJen Tsao; Pamela A Lally; Kevin P Lally;
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  46     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-20     Completed Date:  2011-10-31     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1158-64     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Inc.
Affiliation:
Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, Houston, TX 77030, USA. kuojen.tsao@uth.tmc.edu
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Cohort Studies
Confidence Intervals
Female
Follow-Up Studies
Hernia, Diaphragmatic / congenital*,  diagnosis,  mortality,  surgery
Humans
Infant
Infant, Newborn
Laparoscopy / adverse effects,  methods
Length of Stay
Male
Odds Ratio
Postoperative Complications / epidemiology,  physiopathology
Recurrence / prevention & control
Registries
Reoperation / statistics & numerical data
Surgical Procedures, Minimally Invasive / adverse effects,  methods*
Survival Rate
Thoracoscopy / adverse effects,  methods*
Treatment Outcome
United States
Grant Support
ID/Acronym/Agency:
L40 HD062427-01/HD/NICHD NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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