Surgical correction of congenital diaphragmatic eventration in children
DOI:
https://doi.org/10.15574/PS.2025.4(89).2531Keywords:
congenital malformation, children, congenital diaphragmatic eventration, surgical treatment, diaphragmatic plastic surgery, diaphragmatic clampsAbstract
Aim - to optimize the surgical correction of congenital diaphragmatic eventration (CDE) by improving diaphragmatic plastic surgery using original instrumentation.
Materials and methods. A retrospective and prospective study of medical records of 29 children with CDE was conducted over the past 30 years. To evaluate the results of treatment, clinical, radiological and statistical methods were used. The presence or absence of relapses, as well as intra- and postoperative complications, were determined.
Results. In diaphragmatic plastic surgery in children with CDE, the following methods were used: triplication ("manual"), using P-like and knotted sutures in 8 (42.1%) patients; triplication using original diaphragmatic clamps - in 5 (26.3%) children; "coat" type duplication, with partial resection of the eventrated diaphragm - in 4 (21.1%); resection of the eventrated part of the diaphragm with its "joint-to-joint" plastic surgery in 2 (10.5%) patients.
Conclusions. Surgical correction of congenital diaphragmatic eventration is an effective method of treating this pathology. The main method of diaphragmatic plastic surgery in CDE is its plication (duplication or triplication method). In cases of traumatic injury to the eventrated diaphragm or in the presence of a pronounced connective process between it and adjacent herniated organs or with the lung, it is advisable to resect the changed areas of the eventrated diaphragm with suturing of its edges. The developed modification of the triplication method, using original diaphragmatic clamps, allows to restore the physiological contour of the diaphragm, ensure the safety of the operation, reduce its duration and simplify the technique of surgical intervention. The open method of diaphragmatic plastic surgery for CDE, using thoracotomy, in 100% of cases prevented the development of recurrent eventration and was accompanied by a good effect after surgery.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.
The authors declare no conflict of interest.
References
Ahmad M, Raza TA, Qadeer K et al. (2020). Eventration of diaphragm in pediatric age group 10 years' experience. KJMS. 13; 1: 5-8.
Saha S, Bal HS, Sen S. (2015, May). Spontaneous rupture of a congenital diaphragmatic eventration in an infant. BMJ Case Rep. 14; 2015: bcr2015208634. https://doi.org/10.1136/bcr-2014-208634; PMid:25976306 PMCid:PMC4434382
Alshorbagy A, Mubarak Y. (2015). Open transthoracic plication of the diaphragm for unilateral diaphragmatic eventration in infants and children. Korean J. Thorac. Cardiovasc. Surg. 48: 307-310. https://doi.org/10.5090/kjtcs.2015.48.5.307; PMid:26509123 PMCid:PMC4622030
Borruto FA, Ferreira CG, Kaselas C et al. (2014, Aug). Thoracoscopic treatment of congenital diaphragmatic eventration in children: lessons learned after 15 years of experience. European J. Pediatr. Surg. 24(4): 328-331. Epub 2013 Jun 19. https://doi.org/10.1055/s-0033-1349054; PMid:23784749
Xu PP, Chang XP, Tang ST, Li S, Cao GQ, Zhang X et al. (2020, Dec). Robot-assisted thoracoscopic plication for diaphragmatic eventration. J Pediatr Surg. 55(12): 2787-2790. https://doi.org/10.1016/j.jpedsurg.2020.06.034; PMid:32711940
Obara H, Hoshina H, Jwais et al. (1987, Jul). Eventration of the diaphragm in infants and children. Acta. Pediatr. Scand. 76(4): 654-658. https://doi.org/10.1111/j.1651-2227.1987.tb10536.x; PMid:3630683
Zhao S, Pan Z, Li Y et al. (2020, Nov 4). Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution. BMC Surg. 20(1): 270. https://doi.org/10.1186/s12893-020-00928-z; PMid:33148241 PMCid:PMC7640684
Wu S, Zang N, Zhu J et al. (2015). Congenital diaphragmatic eventration in children: 12 years' experience with 177 cases in a single institution. J. Pediatr. Surg. 50(7): 1088-1092. https://doi.org/10.1016/j.jpedsurg.2014.09.055; PMid:25783408
Ghribi A, Bonden A, Braiki M et al. (2015). Diaphragmatic eventration in children. Tunis Med. 93(2): 76-78.
Guzman-Valderrabano CR, Hernandez-Saldano Soto Ramos M. Et al. (2017). Eventracion diaphragmatica congentaen un paciente de nueve meses: presentation de casoclsnico y revision de la literature. Neumol Cir Torax. 76; 1: 24-29. https://doi.org/10.35366/71355
Clifton MS, Wulkan ML. (2017, Dec). Congenital diaphragmatic hernia and diaphragmatic eventration. Clin Perinatol. 44(4): 773-779. https://doi.org/10.1016/j.clp.2017.08.011; PMid:29127959
Bawazir OA, Banaja AM. (2019, Jun). Thoracoscopic repair of diaphragmatic eventration in children: a comparison of two repair techniques. Journal of Pediatric Surgery. 55(6): 1152-1156. Epub 2019 Dec 28. https://doi.org/10.1016/j.jpedsurg.2019.11.019; PMid:31937447
Sing G, Rai RK, Pant N et al (2020, Jun). Study of thoracoscopic repair of diaphragmatic eventration in children: a case series. J Laparoendosc Adv Surg Tech A. 30(6): 692-694. https://doi.org/10.1089/lap.2019.0805; PMid:32155102
Gupta A, Sidler M, van Poll D, Patel N, Eaton S et al. (2020, Feb). Thoracic versus abdominal approach to correct diaphragmatic eventration in children. J Pediatr Surg. 55(2): 245-248. Epub 2019 Nov 2. https://doi.org/10.1016/j.jpedsurg.2019.10.040; PMid:31761454
Lao VV, Lao OB, Abdessalam SF. (2013, Sep). Laparoscopic transperitoneal repair of pediatric diaphragm eventration using an Endostapler Device. J. Laparoscopic & Advanced Surgical Techniques. 23(9):808-813. Epub 2013 Aug 12. https://doi.org/10.1089/lap.2013.0113; PMid:23937143 PMCid:PMC3806401
Parlak A, Gurpinar AN, Dogruyal H. (2020, May). Double purse - string suturing: An easy plication technique in thoracoscopic repair of diaphragmatic eventration. J. Pediatr. Surg. 55(5): 967-971. Epub 2019 Nov 17. https://doi.org/10.1016/j.jpedsurg.2019.10.018; PMid:31761455
Sliepov OK, Danilov OA, Sliepov Ie. O. (2024). Congenital malformation - diaphragmatic eventration in children: clinic, diagnosis and treatment tactics. Paediatric Surgery (Ukraine). 3(84): 51-57. https://doi.org/10.15574/PS.2024.3(84).5157
Chandrasekaron A, Mulla AJ, Patel R et al. (2021). A rare constellation of eventration of right diaphragm, severe right lung hypoplasia and LPA sling. Indian Journal Thoracic and Cardiovascular Surgery. 37(1): 101-104. https://doi.org/10.1007/s12055-020-00964-7; PMid:33442215 PMCid:PMC7778632
Sliepov OK, Sliepov Ie. O. (2009). Zatyskach khirurhichnyi diafrahmalnyi. Patent Ukrainy na vynakhid No. 86332, A61V17/28. Zaiavl. 15.05.2008. Opubl. 10.04.2009, Biul. No. 7.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Paediatric Surgery (Ukraine)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
