ORIGINAL ARTICLE Surgical intervention for congenital diaphragmatic hernia: open versus thoracoscopic surgery Takaaki Tanaka • Tadaharu Okazaki • Yumi Fukatsu • Manabu Okawada • Hiroyuki Koga • Go Miyano • Yuki Ogasawara • Geoffrey J. Lane • Atsuyuki Yamataka Published online: 24 August 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Purpose To compare open repair (OR) with thoraco- scopic repair (TR) for congenital diaphragmatic hernia (CDH) in neonates. Methods Twenty-four neonatal CDH cases diagnosed prenatally or within 6 h of birth at our institute from 2002 to 2012 with mild pulmonary hypertension managed without inhaled nitric oxide, were studied. OR was routine until 2006 (n = 14; L:R = 12:2) and TR became routine in 2007 (n = 10; L:R = 10:0). All subjects had identical management. Results Gestational age at birth: OR 37.4 ± 1.6 vs. TR: 38.3 ± 1.1 weeks (p = 0.10); birth weight 2,636 ± 490 vs. 2,887 ± 429 grams (p = 0.20); preoperative A-aDO 2 : 308 ± 200 vs. 331 ± 195 mmHg (p = 0.79); and operat- ing time (min): 161 ± 42 vs. 194 ± 76 (p = 0.27). In TR, intraoperative cardiopulmonary status was stable, intraop- erative hemorrhage was significantly less (4.8 ± 6.0 vs. 1.1 ± 0.1 grams; p = 0.038), wound cosmesis was excel- lent without surgical site infections, while, maximum postoperative CRP (2.0 ± 1.5 vs. 1.5 ± 1.1 mg/dL; p = 0.30), commencement of enteral feeding (6.9 ± 2.8 vs. 5.6 ± 2.8 days; p = 0.27), and length of postoperative hospitalization (36 ± 22 vs. 34 ± 12 days; p = 0.66) were improved, but not significantly. One OR case required surgery for intestinal obstruction. Conclusions Thoracoscopic repair appears to be as effective as OR for treating selected cases of CDH in neonates, with excellent wound cosmesis. Keywords Congenital diaphragmatic hernia Á Minimally invasive surgery Á Thoracoscopy Á Open surgery Á Outcome Introduction Since the first reports of laparoscopic [1] and thoracoscopic [2] repair of congenital diaphragmatic hernia (CDH) in 1995, the role of minimally invasive surgery (MIS) for the treatment of CDH in neonates has grown [3]. Intuitively, CDH patients treated by MIS should benefit from less pain and incisional complications, avoidance of the sequelae of thoracotomy or laparotomy, and reduced surgical stress compared with tra- ditional open repair (OR), although there are specific disad- vantages including CO 2 absorption during insufflation for creating a pneumothorax/pneumoperitoneum, which can lead to significant metabolic and physiologic changes [4, 5]. However, comparative studies between MIS and OR have not been conducted extensively due to wide discrepancies in the severity of pulmonary hypoplasia (PH) and persistent pul- monary hypertension (PPH) between patients and different management protocols resulting in the indications for MIS to vary from center to center. We began using thoracoscopic repair (TR) for CDH at our institute in 2007, for treating selected cases diagnosed pre- natally or within 6 h of birth [6], with stable cardiopulmo- nary status not requiring inhaled nitric oxide (NO) [7]. In this study, we compared intra- and postoperative outcome of OR and TR cases at a single pediatric surgical center to evaluate the feasibility of TR for neonatal CDH repair. T. Tanaka Á T. Okazaki (&) Á Y. Fukatsu Á Y. Ogasawara Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan e-mail: okazakit@juntendo.ac.jp T. Tanaka Á M. Okawada Á H. Koga Á G. Miyano Á G. J. Lane Á A. Yamataka Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan 123 Pediatr Surg Int (2013) 29:1183–1186 DOI 10.1007/s00383-013-3382-9