ANATOMICAL VARIATIONS OF CONGENITAL DIAPHRAGMATIC HERNIA DURING THORACOSCOPIC REPAIR :A TWO EGYPTIAN CENTERS EXPERIENCE

Osama Hassan, Ahmed; Ezzat Mohamed Rozik, Ahmed; Mohamed Ali Tantawy, Ismail; Magdy El Barbary, Mohamed

doi:10.21608/zumj.2019.30948

ANATOMICAL VARIATIONS OF CONGENITAL DIAPHRAGMATIC HERNIA DURING THORACOSCOPIC REPAIR :A TWO EGYPTIAN CENTERS EXPERIENCE

Document Type : Original Article

Authors

10.21608/zumj.2019.30948

Abstract

Background: Congenital diaphragmatic hernia is a major problem in pediatric patients specially neonates with subsequent high morbidity and mortality. Thoracoscopic repair is now being considered the primary choice in management of such patients. The present work aims at evaluating the different anatomical characteristics and variations of congenital diaphragmatic defects during thoracoscopic repair.
Methods: Thirty patients with congenital diaphragmatic hernia were included in the study. Thoracoscopic inspection of the defect and its anatomical characters was followed by repair. Data were recorded regarding symptoms, radiological findings, anatomic landmarks and variations during the procedure itself.
Results: A higher incidence of congenital diaphragmatic hernia in infantile male population was documented with a higher incidence of left sided defect (96.7%). Postero-lateraldefects were common (86.7%) compared to lateral defect. Hernial sac was absent in 90% of cases. Most of cases had anterolateral muscular rim (86.7%). Liver herniation occurred in only two cases (6.7%). The majority of patients had moderate organ displacement (70%). Thoracoscopic repair was successful in 90% of cases. Primary repair was done in all cases with no need of synthetic patches.
Conclusion: The use of thoracoscope helps in creation of a strict phenotyping system that will enhance the ability to predict the clinical course of diaphragmatic defects and will aid in identifying developmental pathways responsible for the disease.

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