Abstract
The use of thoracoscopy and laparoscopy in the treatment of congenital diaphragmatic hernias (CDHs) has been recently reported; however, the use of these procedures still remains controversial due to CO2 insufflation and limited working space. In addition, because of difficult techniques, it has not been widely accepted. Among CDH patients, mild cases whose lung is not hypoplastic, and not associated with persistent pulmonary hypertension of the neonate (PPHN) often develop small defects in the diaphragm that can be repaired using “direct closure.” Because direct closure does not require as wide an operative field as that needed for patch closure, we repaired CDH through umbilical skin windows in two neonates with mild CDH to minimize the wounds. With the creation of additional radical small incisions, the surgeries were successfully performed without any intra- or postoperative complications, and the wounds were cosmetically pleasing. The repair of CDHs through umbilical skin windows is a feasible and useful approach in neonates with mild CDH.
References
Usui N, Okuyama H, Sawai T, Kamiyama M, Kamata S, Fukuzawa M (2007) Relationship between L/T ratio and LHR in the prenatal assessment of pulmonary hypoplasia in congenital diaphragmatic hernia. Pediatr Surg Int 23:971–976
Kitano Y, Okuyama H, Saito M, Usui N, Morikawa N, Masumoto K et al (2011) Re-evaluation of stomach position as a simple prognostic factor in fetal left congenital diaphragmatic hernia: a multicenter survey in Japan. Ultrasound Obstet Gynecol 37:277–282
Odaka A, Hashimoto D (2005) Umbilical approach using the sliding-window method to avoid a large abdominal incision: report of two pediatric cases. Pediatr Surg Int 21:928–931
Tajiri T, Ieiri S, Kinoshita Y, Masumoto K, Nishimoto Y, Taguchi T (2008) Transumbilical approach for neonatal surgical diseases: woundless operation. Pediatr Surg Int 24:1123–1126
Takahashi Y, Tajiri T, Masumoto K, Kinoshita Y, Ieiri S, Matsuura T et al (2010) Umbilical crease incision for duodenal atresia achieves excellent cosmetic results. Pediatr Surg Int 26:963–966
Hasegawa T, Kamata S, Imura K, Ishikawa S, Okuyama H, Okada A et al (1990) Use of lung-thorax transverse area ratio in the antenatal evaluation of lung hypoplasia in congenital diaphragmatic hernia. J Clin Ultrasound 18:705–709
Kamata S, Hasegawa T, Ishikawa S, Usui N, Okuyama H, Kawahara H et al (1992) Prenatal diagnosis of congenital diaphragmatic hernia and perinatal care: assessment of lung hypoplasia. Early Hum Dev 29:375–379
Acknowledgments
The authors thank Dr. Brian Quinn, Japan Medical Communication for editing this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Uehara, S., Usui, N., Kamiyama, M. et al. Repair of congenital diaphragmatic hernias through umbilical skin incisions. Pediatr Surg Int 29, 529–532 (2013). https://doi.org/10.1007/s00383-013-3265-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-013-3265-0