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Eur J Pediatr Surg
DOI: 10.1055/a-2540-3862
Original Article

Comparative Outcomes of Surgical Techniques for Congenital Diaphragmatic Eventration in Children: A Multicenter Retrospective Cohort Analysis

Khalid Alzahrani 
1   Department of Surgery, Al-Baha University, Alaqiq, Saudi Arabia
2   Pediatric Surgery Department, Angers University Hospital, Angers, Pays de la Loire, France
,
Lymeymey Heng
2   Pediatric Surgery Department, Angers University Hospital, Angers, Pays de la Loire, France
,
Naziha Khen-dunlop
3   Departement of Pediatric Surgery, Necker-Enfants malades Hospital, Paris, France
4   Department of Pediatric Surgery, American Hospital of Paris, Neuilly-sur-Seine, France
,
Nicoleta Panait
5   Pediatric surgery Department, Marseille Public University Hospital System, Marseille, Provence-Alpes-Côte d'Azur, France
,
Erik Hervieux
6   Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand-Trousseau, Paris, France
,
Lucie Grynberg
7   Department of Pediatric and Adolescent Surgery, Rouen University Hospital, Rouen, Normandy, France
,
Abbo Olivier 
8   Service de Chirurgie - Hopital des enfants, CHU Toulouse, Toulouse, France
,
Frédéric Hameury
9   Pediatric Surgery Department, University Hospital Centre Lyon, Lyon, Auvergne-Rhône-Alpes, France
,
Frédéric Lavrand
10   Pediatric Surgery Department, University Hospital Centre Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
,
Olivier Maillet
11   Pediatric Surgery Department, University Hospital of Montpellier, Montpellier, Occitanie, France
,
Aurore Haffreingue
12   Pediatric Surgery Department, University Hospital Centre Caen, Caen, Normandie, France
,
Anne Lehn 
13   Department of Pediatric Surgery, Hopitaux universitaires de Strasbourg, Strasbourg, France
,
Stephan de Napoli-Cocci
14   Pediatric Surgery Department, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
,
Edouard Habonimana
15   Pediatric Surgery Department, Rennes University Hospital, Rennes, Bretagne, France
,
Jean-Luc Michel
16   Pediatric Surgery Department, Centre Hospitalier Universitaire de La Reunion, Saint-Denis, La Réunion, Réunion
,
Louise Montalva 
17   Pediatric Surgery Department, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
,
Quentin Ballouhey
18   Pediatric Surgery Unit, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
,
Arnaud Fotso Kamdem
19   Pediatric Surgery Department, Besançon Regional University Hospital Center, Besancon, Bourgogne-Franche-Comté, France
,
Jean-François Lecompte
20   Pediatric Surgery Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, Provence-Alpes-Côte d'Azu, France
,
Antoine Line
21   Pediatric Surgery Department, University Hospital Centre Reims, Reims, Grand Est, France
,
Anna Poupalou
22   Pediatric Surgery Department, HUDERF, Bruxelles, Bruxelles, Belgium
,
Pierre Meignan
23   Department of Pediatric Surgery, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
,
Loren Deslandes
24   Pediatric Surgery Department, University Hospital Centre Clermont-Ferrand, Clermont-Ferrand, France
,
Guillaume Podevin
2   Pediatric Surgery Department, Angers University Hospital, Angers, Pays de la Loire, France
,
Françoise Schmitt
2   Pediatric Surgery Department, Angers University Hospital, Angers, Pays de la Loire, France
› Author Affiliations Funding None.
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Abstract

Introduction

This study compares various surgical approaches for treating congenital diaphragmatic eventration (CDE) in children to identify the most effective and safest method.

Methods

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).

Results

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, p < 0.0001) and hospital stay length by two (8 vs. 4 days, p = 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.

Conclusion

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.

Keywords

congenital diaphragmatic eventration - diaphragmatic plication - thoracoscopic plication - mini-invasive surgery - robot-assisted thoracoscopy

Supplementary Material



Publication History

Received: 07 August 2024

Accepted: 15 February 2025

Accepted Manuscript online:
18 February 2025

Article published online:
18 March 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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