eprintid: 10108572
rev_number: 28
eprint_status: archive
userid: 608
dir: disk0/10/10/85/72
datestamp: 2020-08-27 13:43:28
lastmod: 2021-12-05 01:04:05
status_changed: 2021-04-23 13:43:46
type: article
metadata_visibility: show
creators_name: De Bie, F
creators_name: Suply, E
creators_name: Verbelen, T
creators_name: Vanstraelen, S
creators_name: Debeer, A
creators_name: Cross, K
creators_name: Curry, J
creators_name: Coosemans, W
creators_name: Deprest, J
creators_name: De Coppi, P
creators_name: Decaluwé, H
title: Early surgical complications after congenital diaphragmatic hernia repair by thoracotomy vs. laparotomy: A bicentric comparison
ispublished: pub
subjects: GOSH
divisions: UCL
divisions: B02
divisions: D13
divisions: G22
keywords: Complications, Congenital diaphragmatic hernia, Laparotomy, Open repair, Thoracotomy
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: 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.
date: 2020-10
date_type: published
official_url: https://doi.org/10.1016/j.jpedsurg.2019.12.020
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1750095
doi: 10.1016/j.jpedsurg.2019.12.020
pii: S0022-3468(19)30930-3
lyricists_name: De Coppi, Paolo
lyricists_id: PDECO50
actors_name: Austen, Jennifer
actors_id: JAUST66
actors_role: owner
full_text_status: public
publication: Journal of Pediatric Surgery
volume: 55
number: 10
pagerange: 2105-2110
event_location: United States
citation:        De Bie, F;    Suply, E;    Verbelen, T;    Vanstraelen, S;    Debeer, A;    Cross, K;    Curry, J;                 ... Decaluwé, H; + view all <#>        De Bie, F;  Suply, E;  Verbelen, T;  Vanstraelen, S;  Debeer, A;  Cross, K;  Curry, J;  Coosemans, W;  Deprest, J;  De Coppi, P;  Decaluwé, H;   - view fewer <#>    (2020)    Early surgical complications after congenital diaphragmatic hernia repair by thoracotomy vs. laparotomy: A bicentric comparison.                   Journal of Pediatric Surgery , 55  (10)   pp. 2105-2110.    10.1016/j.jpedsurg.2019.12.020 <https://doi.org/10.1016/j.jpedsurg.2019.12.020>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10108572/3/De%20Coppi_Early%20surgical%20complications%20after%20CDH%20repair%20by%20thoracotomy%20vs%20laparotomy%20a%20bicentric%20comparison_20191115_reviewed_FDB%20PDC.pdf