Thoracoscopic Plication for Bilateral Eventration of Diaphragm in a Neonate

Saravanan N*; Ramalingam R; Subramanian H

Sri Gokulam Hospitals, Salem, India

Correspondence: *. Correspondence: Saravanan Natarajan, Sri Gokulam Hospitals, Salem, India. E-mail: E-mail:

Received: 2015 April 12; Accepted: 2015 June 25

J Neonat Surg. 2015 Jul 1; 4(3): 35

Copyright

Copyright: © 2015 JNS


Dear Sir

A 6-day-old female baby delivered by Caeserean section was admitted for respiratory distress. On admission, the baby was tachypnoeic, respiratory rate more than 60/ min with cyanosis requiring oxygen of 8 l/min to maintain satisfactory O2 saturation. An X-ray chest and abdomen taken, was suggestive of bilateral eventration of diaphragm (Fig. 1). An USG and CT scan confirmed the diagnosis. The ECHO done was normal.


[Figure ID: F1] Figure 1: Bilateral eventration of diaphragm.

Baby was taken up for thoracoscopic corrective procedure. It was decided randomly to operate on the left side first. With the baby in lateral decubitus position, a 5mm optical port was introduced for 30 0 telescope in the mid -axillary line at 4th inter costal space. Two additional working ports of 5 mm were introduced in the anterior and posterior axillary lines at 5th inter costal space. Thoracoscopy was done with CO2 at a flow rate of 0.50-1 l/min with pressure 5-6 mm Hg. The eventration was picked up with forceps, carefully avoiding underlying structures. Plication was done with 2-0 polypropylene interrupted sutures tied extracorporeally and pushed down with knot pusher. No clamp or retractor was used. An intercostal drainage tube was introduced, and the baby recovered well. No ventilatory support was needed. Post-operative X-ray showed left hemi diaphragm at normal level. But on right side it had gone further up, may be due to increased intra- abdominal contents. The baby was recovering well, started on tube feeds, but still needed 1-2 lit/min of oxygen. So it was decided to go for right side repair on 6th postoperative day. Thoracoscopic plication of right side diaphragm was done in the same way. Baby had an uneventful recovery. Both ICDs were removed and baby was discharged after 5 days. Baby is on follow up for more than 6 months and is doing well.

Eventration diaphragm is a disorder in which all or part of diaphragmatic muscle is replaced by fibro-elastic tissue [1,2]. It can be congenital or acquired. Bilateral congenital eventration of diaphragm is a relatively rare occurrence [1]. Minimally invasive procedures are being used for the treatment of eventration for the last 2 decades [2,3]; the advantages quoted in favour of thoracoscopic over open surgical approach clinical reduction in perception of pain, less post-operative morbidity and dysfunction[4] To the best of our knowledge, only few references could be gathered about bilateral eventration and none describing thoracoscopic management for bilateral eventration in a new born.[1,5]

Footnotes

Source of Support: Nil

Conflict of Interest: None


References
1. Rodgers BM, Hawks P. Bilateral congenital eventration of the diaphragms: successful surgical management. J Pediatr Surg. 1986; 21:858-64.
2. Mouroux J, Padovani B, Poirier NC, Benchimol D, Bourgeon A, Deslauriers J, et al. Technique for the repair of diaphragmatic eventration. Ann Thorac Surg. 1996; 62:905-7.
3. Van Smith C, Jacobs JP, Burke RP. Minimally invasive diaphragm plication in an infant. Ann Thorac Surg. 1998; 65:842-4.
4. Becmeur F, Talon I, Schaarschmidt K, Philippe P, Moog R, Kauffmann I, et al. Thoracoscopic diaphragmatic eventration repair in children: about 10 cases. J Pediatr Surg. 2005; 40:1712-5.
5. Ahmed Z, Mohyuddin Z. Congenital bilateral diaphragmatic eventration--a rare anomaly with complicated perioperative care. J Pak Med Assoc. 1998;48:221-5.

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