Thoracoscopic repair of congenital diaphragmatic hernia

Posted by Jafrul Hannan on Thu, Oct 15, 2009  
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A 9 day old male child was transferred to my department with h/o respiratory distress since birth. He was diagnosed as birth asphyxia by the neonatologist and a chest X-Ray revealed the left sided diaphragmatic hernia with mediastinal shift. Thoracoscopy was planned and the patient was prepared accordingly. Under general endotracheal anesthesia the baby was placed in supine position with left side up. The left arm was placed above the head keeping it abducted. The first 5 mm port was placed in mid-axillary line in the 4th intercostal space. The introduction of telescope revealed the abdominal contents in the left hemi-thorax but separated by a thin septa. The CO2 insufflation done with pressure at 6 mmHg which helped reducing the abdominal contents. Two more 5 mm ports were placed at the same level in anterior and posterior axillary lines. Using a needle holder in right hand and a Marryland forceps in the left interrupted suturing of the diaphragmatic defect was performed with 4/0 vicryl. The ports were then closed keeping a drain in the chest. A chest X-Ray on the following morning showed significant chest expansion with correction of mediastinal shift and another X-Ray after one week showed complete expansion and the baby took breaths normally.

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