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Background <p>Congenital diaphragmatic hernia (CDH) is a condition linked to neonatal morbidity, mortality, and gastroesophageal reflux. Traditional hiatoplasty via laparotomy or laparoscopy is complicated by abdominal adhesions from previous CDH repair. A thoracoscopic technique, avoiding abdominal preparation, was introduced to address these issues. This study evaluates its safety and efficacy in children with CDH.</p> Methods <p>A prospective, propensity-matched study was conducted on pediatric patients undergoing thoracoscopic hiatoplasty (TH) or hiatoplasty via laparotomy for CDH at University Hospital Mannheim (2013–2024). Outcomes included operative time, ICU LOS and overall hospital stay (LOS), complication rates, and recovery, assessed via parent-reported questionnaires.</p> Results <p>57 children underwent hiatoplasty via laparotomy, while 12 had TH. Propensity matching yielded 27 patients (laparotomy n = 19, TH n = 8). TH showed shorter operative time (71.5 vs 190.5 min; <i>p</i> = 0.0018), reduced ICU LOS (0.1 ± 0.3 vs 1.6 ± 4.0 days; <i>p</i> = 0.0002), and shorter overall LOS (2.4 ± 1.1 vs 13.2 ± 6.1 days; <i>p</i> &lt; 0.0001). Complications were fewer (<i>p</i> = 0.0022), and dietary progression improved (<i>p</i> = 0.0181), with a trend toward earlier sports resumption (<i>p</i> = 0.0545). Follow-up duration was markedly shorter in the TH group (median 109 days [IQR 70–151] vs. 1465 days [IQR 924–2390], <i>p</i> = 0.0041).</p> Conclusion <p>TH is a safe, effective antireflux therapy for CDH, offering better recovery and fewer complications. Interpretation is limited by the shorter follow-up in the thoracoscopic group. Long-term randomized trials are needed to confirm these results.</p>

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Thoracoscopic hiatoplasty in congenital diaphragmatic hernia is safe and less invasive: a prospective propensity-matched short-term study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月21日

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  • Michaela Klinke,
  • Richard Martel,
  • Christel Weiß,
  • Christoph Mohr,
  • Thomas Schaible,
  • Nina Dietze,
  • Jana Hoffmann,
  • Michael Boettcher,
  • Julia Elrod

摘要

Background

Congenital diaphragmatic hernia (CDH) is a condition linked to neonatal morbidity, mortality, and gastroesophageal reflux. Traditional hiatoplasty via laparotomy or laparoscopy is complicated by abdominal adhesions from previous CDH repair. A thoracoscopic technique, avoiding abdominal preparation, was introduced to address these issues. This study evaluates its safety and efficacy in children with CDH.

Methods

A prospective, propensity-matched study was conducted on pediatric patients undergoing thoracoscopic hiatoplasty (TH) or hiatoplasty via laparotomy for CDH at University Hospital Mannheim (2013–2024). Outcomes included operative time, ICU LOS and overall hospital stay (LOS), complication rates, and recovery, assessed via parent-reported questionnaires.

Results

57 children underwent hiatoplasty via laparotomy, while 12 had TH. Propensity matching yielded 27 patients (laparotomy n = 19, TH n = 8). TH showed shorter operative time (71.5 vs 190.5 min; p = 0.0018), reduced ICU LOS (0.1 ± 0.3 vs 1.6 ± 4.0 days; p = 0.0002), and shorter overall LOS (2.4 ± 1.1 vs 13.2 ± 6.1 days; p < 0.0001). Complications were fewer (p = 0.0022), and dietary progression improved (p = 0.0181), with a trend toward earlier sports resumption (p = 0.0545). Follow-up duration was markedly shorter in the TH group (median 109 days [IQR 70–151] vs. 1465 days [IQR 924–2390], p = 0.0041).

Conclusion

TH is a safe, effective antireflux therapy for CDH, offering better recovery and fewer complications. Interpretation is limited by the shorter follow-up in the thoracoscopic group. Long-term randomized trials are needed to confirm these results.