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Thoracic versus abdominal approach to correct diaphragmatic eventration in children

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.

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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.

Type: Article
Title: Thoracic versus abdominal approach to correct diaphragmatic eventration in children
DOI: 10.1016/j.jpedsurg.2019.10.040
Publisher version: https://doi.org/10.1016/j.jpedsurg.2019.10.040
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Diaphragmatic eventration, Plication, Thoracotomy, Thoracoscopy, Laparotomy, Laparoscopy
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10081715
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