Thoracoscopic plication in children with diaphragmatic eventration: a case series

Plicatura por toracoscopia en niños con eventración diafragmática. Serie de casos

Introduction: Diaphragmatic eventration is characterized by an elevation of the hemidiaphragm without continuity defects, its incidence is 0.02-0.07 per 1000 births in congenital and 0.3-13% acquired ones. Objective: to report our initial experience of plication by thoracoscopy in 3 children with diaphragmatic eventration. Materials and methods: Thoracoscopically using a 3 mm trocar in the mid axillary line in the fourth intercostal space where the 30 degree optic was inserted, and a 3 mm trocar in the anterior axillary line in the fifth intercostal space, subsequently an 18G gauge spinal needle was inserted in the posterior part of the thorax making several folds in the diaphragm, a suture is introduced up to the other end of the external cannula of the needle, the external cannula of the spinal needle is extracted, then the extracorporeal knot is made making the diaphragm plication. Results: 3 patients were included, the median age was 1 month (range: 1-4 months), 2 (67%) were girls and 1(33%) boy, the median weight at the time of surgery was 2500 grams (range: 2200-5200 grams), 2 (67%) patients had left sided and 1(33%) right sided eventration, 2 (67%) patients had acquired diaphragmatic eventration and 1 (33%) congenital, in no patient was chest tube used at the end of surgery, in all patients feeding was started 24 hours postoperatively, median hospital stay was 15 days (range: 7-16 days), median follow-up was 9 months (range: 6-12 months), no patient has presented recurrence during the follow-up period. Conclusion: Thoracoscopic plication with 2 trocars, a spinal needle and extracorporeal suture is a safe and effective minimally invasive technique for the treatment of diaphragmatic eventration.