Comparative Outcomes of Surgical Techniques for Congenital Diaphragmatic Eventration in Children: A Multicenter Retrospective Cohort Analysis.

Abstract

Introduction: This study compares various surgical approaches for treating congenital diaphragmatic eventration (CDE) in children to identify the most effective and safest method.

Methods: we conducted a retrospective analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021. The different surgical approaches, including robot-assisted thoracoscopic surgery (RATS), and their outcomes were compared. (Clinical Trials NCT04862494).

Results: 112 patients, aged 12 [5 - 21] months, underwent diaphragmatic plication. Thoracoscopy or RATS was performed in 69 (62%) cases, postero-lateral thoracotomy (PLT) in 15 (13%) and an abdominal approach in 28 (25%), based on surgeons' choice. Symptom relief was achieved in 88% of patients, and 90% showed radiographic improvement. There were 31 peri- or early postoperative complications (28%), mainly including pleural effusions, infections and lobar atelectasis, and eight recurrences of eventration (7%), with no significant correlation between these complications and the surgical approach. Compared to other approaches, thoracotomy multiplied the duration of intravenous analgesia by three (96 vs 36h, p<0.0001), and hospital stay length by two (8 vs 4d, p = 0.002). RATS, although comparable to thoracoscopy in short-term outcomes, had a higher incidence of perioperative hepatic injuries and long-term complications, including persistent symptoms in all 5 patients and chest wall deformities in two.

Conclusions: Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. Further research is required to establish potential added risks of RATS as compared to thoracoscopy in this indication.