Retrospective cohort analysis of current trends in the surgical management of congenital diaphragmatic eventration in children

Aim To compare the different surgical approaches for treating congenital diaphragmatic eventration (CDE) in children. Methods Retrospective data analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021, with comparison of the different surgical approaches and their outcomes. Results 112 patients, aged 12 [5–21] months, were operated on for CDE. Diaphragmatic plication was performed using thoracoscopy or RATS in 69 (62%) cases, postero-lateral thoracotomy (PLT) in 15 (13%), and using an abdominal approach in 28 (25%). Relief of symptoms was obtained in 88% of the cases and improvement in the diaphragmatic level in 90%. We recorded 31 postoperative complications (28%) and eight recurrences (7%). Compared to other approaches, PLT multiplied the duration of intravenous analgesia by three (96 vs 36h, p<0.0001) and the length of hospital stay by two (8 vs 4d, p=0.002). RATS provided more perioperative hepatic injuries and equivalent short-term results than thoracoscopy, but all five patients remained symptomatic and two of them experienced chest wall deformities. Conclusion Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. Further is required to confirm that RATS is, at least, not inferior to thoracoscopy. ClinicalTrial NCT04862494 , 2021-04-28;