Comparative study between Extra-pleural versus Trans-pleural approaches in Surgical PDA Ligation in Pediatrics

Background: Patent ductus arteriosus (PDA) is a common congenital heart defect, that can cause cardiorespiratory morbidity, and closure is crucial to prevent complications. New PDA surgical ligation techniques have evolved to improve outcomes and reduce hospital stays.Objectives: To compare the outcome of the extra-pleural versus trans-pleural approaches in surgical PDA ligation.Patients and methods: The study involves 40 PDA patients, divided into two groups: Group A (n=20) ligated via a trans-pleural approach and Group B (n=20) ligated via an extra-pleural approach. The study compares the operative time, intra-operative complications, hospital stays, and post-operative complications.Results: PDA was successfully ligated in all cases except one case which needed redo surgery. The mean age was 7.47 ± 5.1 months with a female-to-male ratio of 2:1. The mean duct size was 4.67 ± 1.36 millimeters. The study found significant differences between the two approaches regarding the operative time (P-Value <0.001), at which group B consumed only 38.67% of total operative time. The surgical morbidities were reduced and intra-operative injuries were better avoided in group B with group A having 77.8% of total intra-operative complications (P-Value <0.001). Post-operative complications were more common in group A (P-Value 0.014). The post-operative hospital stay was markedly reduced in group B (P-Value <0.001). The study also showed significant improvement in LV systolic function, dimensions, and LA/AO ratio at 3 and 6 months post-ligation.Conclusion: The extra-pleural approach is a safer and more effective surgical method for PDA closure due to its reduced morbidities, improved visualization, and shorter operative times.