ORIGINAL ARTICLE Safety of surgery for neonatal congenital diaphragmatic hernia as reflected by arterial blood gas monitoring: thoracoscopic versus open repair Tadaharu Okazaki 1 • Manabu Okawada 2 • Hiroyuki Koga 2 • Go Miyano 2 • Takashi Doi 2 • Yuki Ogasawara 1 • Yuta Yazaki 1,2 • Kinya Nishimura 3 • Eiichi Inada 3 • Geoffrey J. Lane 2 • Atsuyuki Yamataka 2 Accepted: 6 August 2015 Ó Springer-Verlag Berlin Heidelberg 2015 Abstract Purpose We monitored arterial blood gases during tho- racoscopic (TR) and open repair (OR) of congenital diaphragmatic hernia (CDH) to assess the safety of intra- operative hypercapnia and acidosis. Methods We reviewed 30 neonatal CDH cases (OR = 10, TR = 20) diagnosed prenatally or within 6 h of birth at out institution from 2002 to 2014 not requiring inhaled nitric oxide (NO) intraoperatively. OR, routine until 2006 was replaced by TR in 2007. All subjects were managed identically. Results Five TR cases requiring conversion to OR were excluded. Prenatal diagnosis, gestational age at birth, gender, birth weight, and side of CDH were similar. Pre- operative PaCO 2 and pH were not significantly different. However, while intraoperative increase in mean PaCO 2 (38.8–62.8 mmHg; p \ 0.01) and decrease in mean pH (7.44–7.25; p \ 0.01) were significant in TR, intraopera- tive PaCO 2 was \ 70 mmHg in 12/15 cases and intraoper- ative pH was [ 7.20 in 11/15 cases. Both PaCO 2 and pH reverted to normal on completion of surgery; pre- and postoperative results were comparable. There were no postoperative complications. Conclusions It would appear that neonatal cases of CDH not requiring NO can tolerate TR, despite transient rever- sible deterioration in acid/base balance, indicating that TR is safe for the treatment of selected cases of CDH. Keywords Congenital diaphragmatic hernia Á Thoracoscopic repair Á Acidemia Á Hypercapnia Introduction Since the first reports of laparoscopic [1] and thoracoscopic [2] repair of congenital diaphragmatic hernia (CDH) in adolescent cases were reported in 1995, minimally invasive surgery (MIS) has developed progressively and is now being used for treating CDH in neonates [3–6]. MIS has advantages over open surgery, including less pain and incision-related complications, as well as minimization of the sequelae of open surgery (i.e., thoracotomy or laparo- tomy). We began using thoracoscopic repair (TR) for CDH at our institute in 2007 for treating selected cases diagnosed prenatally or soon after birth, with stable cardiopulmonary status not requiring inhaled nitric oxide (NO) [7, 8]. TR cases experienced less surgical stress and postoperative recovery was facilitated with a lower risk for postoperative intestinal obstruction [9]. Recently, the safety of TR was questioned by a study that found TR was associated with prolonged and severe intraoperative hypercapnia and acidosis compared with open repair (OR) [10]. Because of this study, we were prompted to review pre-, intra-, and postoperative arterial blood gases results in our neonatal CDH cases not requir- ing NO to compare OR with TR for safety. & Tadaharu Okazaki okazakit@juntendo.ac.jp 1 Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan 2 Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan 3 Department of Anesthesiology, Juntendo University School of Medicine, Tokyo, Japan 123 Pediatr Surg Int DOI 10.1007/s00383-015-3767-z