eprintid: 10081715 rev_number: 27 eprint_status: archive userid: 608 dir: disk0/10/08/17/15 datestamp: 2019-09-18 08:39:39 lastmod: 2021-12-05 01:03:18 status_changed: 2019-09-18 08:39:39 type: article metadata_visibility: show creators_name: Gupta, A creators_name: Sidler, M creators_name: van Poll, D creators_name: Patel, N creators_name: Eaton, S creators_name: Muthialu, N creators_name: De Coppi, P title: Thoracic versus abdominal approach to correct diaphragmatic eventration in children ispublished: pub subjects: GOSH divisions: UCL divisions: B02 divisions: D13 divisions: G22 keywords: Diaphragmatic eventration, Plication, Thoracotomy, Thoracoscopy, Laparotomy, Laparoscopy note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: Background: Plication of diaphragm (DP) for eventration (DE) can be done using thoracic or abdominal approaches. The purpose of our study was to compare outcomes between these approaches based on our experience and on systematic literature review. Methods: Retrospective records of children < 16 years who underwent DP (single-center, 2004–2018) were recorded and analyzed. Systematic review and meta-analysis of related studies was undertaken. Data are reported as median (range). Results: Eighty-nine cases were identified in thoracic (Congenital = 5, Acquired = 84) and 13 (Congenital = 10, Acquired = 3) in abdominal group aged 5.88 (0.36–184.44) and 10.0 (0.12–181.8) months. Improvement in diaphragm level post-DP was significantly higher in abdominal [2(0–4)] than chest [1.5(0–5)] group (p = 0.04). On Cox regression analysis, there was a non-significant trend to a longer time to extubation in the chest group (Hazard ratio (HR) = 0.539[0.208–1.395], p = 0.203). Patients operated transthoracically left intensive care unit after a significantly longer time (HR = 0.339[0.119–0.966], p = 0.043). Patients operated transabdominally tended to be fed later, although this was not significant (HR = 1.801[0.762–4.253], p = 0.043). On Kaplan–Meier analysis, there was a non-significant trend to a lower rate of recurrence in the abdominal group (HR = 0.3196[0.061–1.675], p = 0.1876). In the meta-analysis including three published studies as well as our data (total n = 181, Thoracic = 139, Abdominal = 42), no difference was found in the incidence of recurrence amongst the 2 groups (RD = -0.04, 95%CI = -0.25, 0.18, p = 0.74). Conclusion: This is one of the largest reports on outcomes of children undergoing DP for DE. There is no significant difference in recurrence rate, even though all recurrences in our series (15.7%) were in the acquired cases operated using a thoracic approach. date: 2020-02 date_type: published publisher: American Academy of Pediatrics official_url: https://doi.org/10.1016/j.jpedsurg.2019.10.040 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1693635 doi: 10.1016/j.jpedsurg.2019.10.040 lyricists_name: De Coppi, Paolo lyricists_name: Eaton, Simon lyricists_name: Sidler, Martin lyricists_id: PDECO50 lyricists_id: SEATO65 lyricists_id: MSIDL53 actors_name: Eaton, Simon actors_id: SEATO65 actors_role: owner full_text_status: public publication: Journal of Pediatric Surgery volume: 55 number: 2 pagerange: 245-248 issn: 1531-5037 citation: Gupta, A; Sidler, M; van Poll, D; Patel, N; Eaton, S; Muthialu, N; De Coppi, P; (2020) Thoracic versus abdominal approach to correct diaphragmatic eventration in children. Journal of Pediatric Surgery , 55 (2) pp. 245-248. 10.1016/j.jpedsurg.2019.10.040 <https://doi.org/10.1016/j.jpedsurg.2019.10.040>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10081715/1/Eventr%20-%20Accepted.pdf