Use of Oxygenation, Ventilation Indices, and Pulmonary Hypertension as Selection Parameters for Thoracoscopic Repair of Congenital Diaphragmatic Hernia, Improved Outcome. Retrospective study

Background: Many reports describing the thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) have been published in the last two decades. These showed the safety and feasibility of the technique. CDH TR was based on selection criteria relying on authors’ experience. Many indices were described to determine preoperative evaluation and prognosis in CDH cases.Purpose: We aim to settle selection criteria to help in selecting CDH cases to improve the outcome of TR in limited resource centres plus usage of oxygenation and ventilation indices as predictors for the postoperative outcome.Methods: Between Jan 2016 to June 2023, 59 ventilated neonates with posterolateral CDH have been subjected to TR. Results: 59 cases were included in the study divided into. Group A: Included 47 survivor patients. Group B: Included 12 non-survivor patients. The mean values for survivors; mean ventilation index (VI) was 474.75 ± 114.01, mean oxygenation index (OI) was 7.95 ± 2.01 and mean oxygenation saturation index (OSI) was 6.95 ± 3.11. There was a correlation of VI, OI, and OSI with mortality where all dead cases have higher values where VI > 500, OI > 10, OS I > 10 and PH < 40 mm Hg.Conclusion: Thoracoscopic repair of CDH is feasible and safe even in countries with limited infrastructure. The selection criteria for good outcomes are VI < 500, OI < 10, OSI < 10, and PH < 40 mm Hg added to the clinical patients’ criteria and surgical expertise.