Marginal Indication for Thoracoscopic Surgery for Neonatal Bochdalek Hernia: “Anchor-Shaped Closure” Technique for the Patient's Own Residual Diaphragm Using a Loop Needle Device

Abstract

Introduction

Surgical procedures to avoid using artificial materials require ongoing discussion. We herein report a case of thoracoscopic repair for congenital diaphragmatic hernia (CDH) via anchor-shaped closure with the patient's own residual diaphragm using a loop needle device.

Patient and Surgical Technique

A 2-day-old boy prenatally diagnosed with CDH underwent thoracoscopic repair after his respiratory and circulatory conditions had stabilized. The defect was a typical Bochdalek CDH, approximately 2.5 × 4 cm. The herniated organs of the thoracic cavity were the stomach, small intestine, colon, spleen, and left kidney. After these organs had been gently returned to the abdominal cavity under artificial pneumothorax, the medial side of the defect was closed in the anterior and posterior directions with six stitches of Loeder's knot using 3–0 non-absorbable sutures. However, the lateral third of the defect was relatively large and difficult to close in the anterior and posterior directions. We therefore opted for closure by fixing the diaphragm to the chest wall and driving five external costal sutures using a loop needle device. The diaphragmatic defect was thus closed in an “anchor-shaped” fashion using the patient's own residual diaphragm. This technique allows artificial membranes to be avoided in infants.

Discussion

Considering the possibility of recurrence and complications, the indications for our procedure are limited; however, we believe that there are cases in which this procedure can provide a cure. Our proposed technique may be effective in closing relatively large diaphragmatic defects.