Comparative Outcomes of Surgical Techniques for Congenital Diaphragmatic Eventration in Children: A Multicenter Retrospective Cohort Analysis
This study compares various surgical approaches for treating congenital diaphragmatic eventration (CDE) in children to identify the most effective and safest method.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).One hundred and twelve patients, aged 12 (5-21) months, underwent diaphragmatic plication. Thoracoscopy or RATS was performed in 69 (62%) cases, posterolateral 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 8 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 h vs. 36 h, <i>p</i> < 0.0001) and hospital stay length by two (8 vs. 4 days, <i>p</i> = 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 five patients and chest wall deformities in two.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.
Authors
- Lucie Grynberg (ORCID: https://orcid.org/0000-0003-3547-0793)
- Olivier Abbo (ORCID: https://orcid.org/0000-0002-4202-4284)
- Naziha Khen‐Dunlop (ORCID: https://orcid.org/0000-0003-4537-229X)
- Édouard Habonimana (ORCID: https://orcid.org/0000-0001-6537-0086)
- Guillaume Podevin
- Pierre Meignan (ORCID: https://orcid.org/0000-0001-8389-4588)
- Arnaud Fotso Kamdem (ORCID: https://orcid.org/0009-0003-4944-9845)
- Loren Deslandes
- Frédéric Hameury (ORCID: https://orcid.org/0000-0002-2243-0103)
- Aurore Haffreingue (ORCID: https://orcid.org/0000-0002-4652-3777)
- S. De Napoli-Cocci
- Louise Montalva (ORCID: https://orcid.org/0000-0001-8357-9609)
- Anne Lehn (ORCID: https://orcid.org/0000-0003-3146-9437)
- Quentin Ballouhey (ORCID: https://orcid.org/0000-0002-6817-9946)
- Erik Hervieux (ORCID: https://orcid.org/0000-0003-2999-1357)
- Françoise Schmitt (ORCID: https://orcid.org/0000-0002-3863-7694)
- frederic Lavrand
- Antoine Liné
- Anna Poupalou (ORCID: https://orcid.org/0009-0006-5325-1075)
- Khalid Alzahrani (ORCID: https://orcid.org/0000-0003-3339-3835)
- Jean‐Luc Michel
- Lymeymey Heng
- Nicoleta Panait
- Olivier Maillet
- Jean‐François Lecompte
Institutions
- Hôpital américain de paris (FR)
- Hôpital Necker-Enfants Malades (FR)
- Université Libre de Bruxelles (BE)
- Centre Hospitalier Universitaire de Nantes (FR)
- Université Rennes 2 (FR)
- Sorbonne Université (FR)
- Institut Necker Enfants Malades (FR)
- Hôpital Armand-Trousseau (FR)
- Assistance Publique Hôpitaux de Marseille (FR)
- Centre Hospitalier Universitaire de La Réunion (RE)
- Centre Hospitalier Universitaire de Besançon (FR)
- Centre Hospitalier Universitaire de Montpellier (FR)
- Centre Hospitalier Universitaire de Tours (FR)
- Communauté urbaine de Lyon (FR)
- Services déconcentrés d'appui à la recherche Nouvelle-Aquitaine-Bordeaux (FR)
- University of Clermont Auvergne (FR)
- Centre Hospitalier Universitaire de Reims (FR)
- Queen Fabiola Children's University Hospital (BE)
- Services déconcentrés d'appui à la recherche Pays de la Loire (FR)
- Leefmilieu Brussel (BE)
- Centre Hospitalier Universitaire de Limoges (FR)
- Université Bourgogne Franche-Comté (FR)
- Mother Hospital (IN)
- Hôpital Robert-Debré (FR)
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- Services déconcentrés d'appui à la recherche Val de Loire (FR)
- Fondation Lenval (FR)
- Hôpitaux Universitaires de Strasbourg (FR)
- Hôpital des Enfants (FR)
- Centre Hospitalier Universitaire de Rennes (FR)
- Université d'Angers (FR)
- Al Baha University (SA)
- Université de Rouen Normandie (FR)
- Université de Reims Champagne-Ardenne (FR)
- Université de Caen Normandie (FR)
Publication Details
- Journal
- European Journal of Pediatric Surgery
- Published
- 2025-02-18
- DOI
- https://doi.org/10.1055/a-2540-3862
- Primary Topic
- Congenital Diaphragmatic Hernia Studies
- Type
- article
- Field-Weighted Citation Impact
- 0.00