Laparoscopic Repair of Diaphragmatic Defects: Congenital Diaphragmatic Hernia (of Bochdalek) and Eventration

Minimally invasive surgery (MIS) is ideally suited to diagnosis and treatment of all forms of diaphragmatic defects. Obviously, the laparoscope affords accurate direct imaging of defects that have classically eluded accurate description by radiological techniques, and does so with minimal morbidity. But laparoscopy also allows repair of these defects with increased precision and vastly decreased pain compared to open techniques that rely on large incisions to give even marginal exposure (Hendrickson et al. 2003). Here we consider the repair of Bochdalek hernias and eventrations using minimally invasive surgical (MIS) techniques in children and newborns. The literature is littered with case reports of MIS repairs of Bochdalek hernias, but virtually all of the descriptions are of repairs in older children and adults (Harinath et al. 2002; Settembre et al. 2003; Willemse et al. 2003). Invariably, these patients had unrecognized congenital diaphragmatic hernias that were revealed during evaluation for other conditions. Alternatively, a few reports describe laparoscopy in the diagnosis or (more rarely) repair of traumatic diaphragmatic hernias (Marin-Blazquez et al. 2003; Matthews et al. 2003). Only one report describes experience with MIS repair of congenital diaphragmatic hernia (CDH) in the newborn, and here the only success came using a thoracoscopic approach (Arca et al. 2003). Nevertheless, CDH can be repaired using MIS techniques. Recently, our institution reported 15 successful repairs of CDH (12 Bochdalek and 3 Morgagni) by laparoscopy (Hendrickson et al. 2003). Twelve of these patients were infants, and recently we successfully repaired Bochdalek CDH (B-CDH) in two additional newborns. The techniques described focus primarily on B-CDH in neonates, but the methods are similar in older children and in patients with eventration. Laparoscopic Repair of Diaphragmatic Defects: Congenital Diaphragmatic Hernia (of Bochdalek) and Eventration