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