TY  - JOUR
VL  - 55
JF  - Journal of Pediatric Surgery
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
TI  - Early surgical complications after congenital diaphragmatic hernia repair by thoracotomy vs. laparotomy: A bicentric comparison
UR  - https://doi.org/10.1016/j.jpedsurg.2019.12.020
Y1  - 2020/10//
ID  - discovery10108572
AV  - public
IS  - 10
EP  - 2110
SP  - 2105
N2  - Purpose:
The surgical strategy for congenital diaphragmatic hernia (CDH) repair remains debated and mainly depends on the training and preference of the surgeon. Our aim was to evaluate the occurrence and nature of surgical reinterventions within the first year of life, following repair through thoracotomy as compared to laparotomy. /

Methods:
This is a retrospective bi-centric cohort study comparing postero-lateral thoracotomy (n?=?55) versus subcostal laparotomy (n?=?62) for CDH repair (IRB: MP001882). We included neonates with isolated, left-sided, Bochdalek-type CDH who were operated on between 2000 and 2017, and had a minimum follow-up of 1 year. Excluded were patients treated prenatally and/or had extra-corporeal membrane oxygenation. Outcomes were occurrence and nature of surgical reinterventions and mortality by 1 year of life. /

Results:
Both groups had comparable neonatal severity risk profiles. The overall surgical reintervention rate by 1 year of age was higher in the thoracotomy group (29.1% vs. 6.5%; p?=?0.001), mainly because of a higher prevalence of acute bowel complications (18.1% vs. 3.2%; p?=?0.012) requiring surgery, such as perforation, obstruction and volvulus. At 1 year of follow-up, groups were similar in terms of recurrence (5.5% vs. 1.6%; p?=?0.341), surgical interventions related to severe gastroesophageal reflux disease (3.6% vs. 1.6%; p?=?0.600) and mortality (5.5% vs. 6.6%; p?=?1.000). /

Conclusion:
Postnatal CDH repair through thoracotomy was associated with a higher rate of surgical reinterventions within the first year of life, especially for severe acute gastro-intestinal complications. There seemed to be no difference in recurrence and mortality rate. /

Type of Study:
Retrospective Comparative Cohort Study. /

Level of Evidence:
Level III.
KW  - Complications
KW  -  Congenital diaphragmatic hernia
KW  -  Laparotomy
KW  -  Open repair
KW  -  Thoracotomy
A1  - De Bie, F
A1  - Suply, E
A1  - Verbelen, T
A1  - Vanstraelen, S
A1  - Debeer, A
A1  - Cross, K
A1  - Curry, J
A1  - Coosemans, W
A1  - Deprest, J
A1  - De Coppi, P
A1  - Decaluwé, H
ER  -