A simple thoracoscopic plication technique for diaphragmatic eventration in neonates and infants: technical details and initial results

Purpose: Existing minimal-access surgical approaches for correction of symptomatic diaphragmatic eventration may be technically difficult in neonates and infants. We report technical details and initial outcomes of a novel, simple thoracoscopic repair technique.Methods: The technique uses one 3-mm camera port, a 3-mm instrument incision without a port, and an 18-gauge spinal needle, which is passed through the chest wall into the pleural space. The excess diaphragm is first plicated over the needle, after which a non-absorbable suture is passed through the needle and tied extracorporeally. The needle is passed repeatedly until the desired degree of tension is achieved. A retrospective review was performed for all patients undergoing repair by this technique.Results: Nine patients have undergone thoracoscopic plication at a median age of 3 months (range 0.2–13.2 mos.) and a median weight of 4.5 kg (range 2.3–8.2 kg). No organ injuries or conversions to thoracotomy occurred. Median operative time was 60 min. Patients repaired beyond the neonatal period were extubated in the operating room. There were two post-operative pneumothoraces. No recurrences have been seen at a mean follow-up of 17 months.Conclusion: This technique of thoracoscopic diaphragm plication is safe, effective, and technically straightforward in neonates and infants.