IPEG 2020 TOP ABSTRACT: Thoracoscopic Repair of Right Congenital Diaphragmatic Hernia on ECMO

July 15, 2020
Presenter: Wendy Jo Svetanoff, MD, MPH
Email: wsvetanoff@cmh.edu
Social Media: @WJSvetanoff @JFrasMD

Authors: Wendy Jo Svetanoff, MD, MPH; Katrina L Weaver, MD; Jason D Fraser, MD; Children's Mercy Hospital, Kansas City, MO, USA

Case Presentation: A male infant was prenatally diagnosed with a right-sided congenital diaphragmatic hernia, with a lung-to-head ratio of 1.1 and liver herniating into the chest. After birth at 39 weeks, he developed respiratory failure requiring veno-arterial extracorporeal membrane oxygen (ECMO) support.

Operative Intervention: A thoracoscopic approach was selected and was performed within 24 hours of ECMO cannulation. The bowel and the liver were reduced into the abdomen and a thin rim of diaphragm posteriorly and medially was found. A 5 x 10cm biologic mesh was placed as an underlay and a 5 x 7.5cm polytetrafluoroethylene mesh was secured to the ribs laterally and to the muscle postero-medially as an overlay.

Conclusion: The patient was decannulated from ECMO, underwent a laparoscopic gastrostomy that showed the repair to be intact, and was discharged home on POD #67. This video demonstrates feasibility of the thoracoscopic repair of right-sided CDH while on ECMO.

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