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Video Presentation - 18
Splenic reduction during thoracoscopic repair of congenital diaphragmatic hernia in children: A safe and simple technique.
N Dessouky
Cairo University Faculty of Medicine , Pediatric Surgical Division, Cairo University Specialized Pediatric Hospital, Egypt
Background:
Splenic reduction during congenital diaphragmatic hernia (CDH) repair is sometimes difficult due to its abnormal shape and large size growing in the thorax. In open surgery, this may necessitate a combined abdomino-thoraxic approach.
With thoracoscopic repairs of CDH, this carries the risk of splenic injury during its reduction either from direct injury with the laparoscopy instrument or from avulsion of the pedicle due to hinged spleen to the edge of the defect during its reduction.
Aim of the work :
To use a safe and simple technique to reduce the spleen during thoracoscopy, even if it is so large without adding too much time to the operation.
Patients and Methods:
A new simple technique is described to reduce the spleen during thoracoscopic repair of 11 children of CDH having no sac with the spleen herniating to the chest with the rest of the contents. The patients’ ages ranged between 7 days and 4 years with a mean of 4.2 months. The procedure entitled a non-grasping technique to reduce the spleen using guidance and gentle side pushs to the splenic poles with the working instruments for thoracoscopy.
Results:
The mean time for splenic reduction did not exceed one minute in all cases, even in large-sized spleens with no injury to the spleen has resulted.
Conclusions:
The technique is a safe, simple and rapid to perform for splenic reduction in CDH repair in children. It minimizes the risk of splenic injury thus maintaining the advantages of thoracoscopic repair of such defects.