Conversion to Open Repair During Thoracoscopic Repair of Congenital Diaphragmatic Hernia in Neonates: Risk Factors and Countermeasures

: There are currently no general guidelines on the selection criteria for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) in neonates, and some patients who are not suitable for the thoracoscopic approach have to be converted to open repair (OR) after undergoing initial thoracoscopy. The aim of this study was to evaluate factors associated with conversion to OR during TR of neonatal cases of CDH and to explore countermeasures against conversion. Medical records of neonates who underwent thoracoscopy for Bochdalek-type CDH at a tertiary center from January 2013 to July 2019 were retrospectively reviewed. We defined two groups: the T group included neonates undergoing complete TR and the TO group included neonates requiring conversion to OR during TR. Thoracoscopy was performed in 58 neonates, with 48 in T group and 10 in TO group. The conversion rate was 17.2%. The proportion of patients with diaphragmatic defect size greater than 6 cm x 5 cm was significantly higher in the TO group than in the T group (30% vs. 2.08%; p = 0.014). The rate of patch use was significantly higher in the TO group compared to the T group (30% vs. 4.17%; p = 0.032). There was no statistically significant difference between the two groups in terms of stomach herniation or liver herniation. The postoperative recurrence rate was 17.78% in the T group and 0% in the TO group (p = 0.39). Defect size greater than 6 cm x 5 cm and patch use were associated with higher conversion rate, while stomach herniation and liver herniation were not. Patients who require conversion but are not actually converted to open repair may have a higher risk of postoperative recurrence.