Laparoscopic transperitoneal repair of pediatric diaphragm eventration using an endostapler device.

Abstract

BACKGROUND:

Minimally invasive repairs of pediatric diaphragm eventration have been well described via a thoracoscopic approach, oftentimes requiring single-lung ventilation and tube thoracostomy, with the disadvantage of not being able to clearly visualize what lies beneath the diaphragm. We describe a novel pediatric diaphragm eventration repair using a laparoscopic transperitoneal approach and an endostapler device. We also describe our initial experience with this technique.

PATIENTS AND METHODS:

Four pediatric diaphragmatic eventration patients underwent laparoscopic transperitoneal repair using an endostapler device. Repairs were performed in both male and female patients with right-sided eventrations. We approach the repair in a transperitoneal fashion using inverting sutures at the apex of the diaphragm to create tension toward the pelvis. Subsequently, an endostapler is used to remove the redundant portion of diaphragm, leaving a repaired, taut diaphragm.

RESULTS:

The median age at operation was 10.5 months. The median operative time was 70 minutes. There was no mortality, surgical complications, or recurrence at a median follow-up of 17 months.

CONCLUSIONS:

This laparoscopic approach allows for clear visualization of the intraabdominal organs and, at least in our early experience, a very simple, straightforward operation. Additionally, with the use of the endostapler, the redundant, often weakened diaphragm is removed, leaving the native, healthy diaphragm behind, resulting in a reliable and reproducible repair. This repair should be considered as a feasible alternative approach to the more traditional open and thoracoscopic repairs.

• Authors: Victoria Valinluck Lao, Oliver B Lao, Shahab F Abdessalam
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 23 Issue 9 Pg. 808-13 (Sep 2013) ISSN: 1557-9034 [Electronic] United States
• PMID: 23937143 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Child
• Diaphragm (surgery)
• Diaphragmatic Eventration (surgery)
• Female
• Humans
• Infant
• Laparoscopy (methods)
• Male
• Minimally Invasive Surgical Procedures
• Operative Time
• Peritoneum (surgery)
• Surgical Stapling (instrumentation, methods)