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