Abstract
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a condition linked to neonatal morbidity, mortality, and gastroesophageal reflux. Traditional hiatoplasty via laparotomy or laparoscopy is complicated by abdominal adhesions from previous CDH repair. A thoracoscopic technique, avoiding abdominal preparation, was introduced to address these issues. This study evaluates its safety and efficacy in children with CDH. METHODS: A prospective, propensity-matched study was conducted on pediatric patients undergoing thoracoscopic hiatoplasty (TH) or hiatoplasty via laparotomy for CDH at University Hospital Mannheim (2013-2024). Outcomes included operative time, ICU LOS and overall hospital stay (LOS), complication rates, and recovery, assessed via parent-reported questionnaires. RESULTS: 57 children underwent hiatoplasty via laparotomy, while 12 had TH. Propensity matching yielded 27 patients (laparotomy n = 19, TH n = 8). TH showed shorter operative time (71.5 vs 190.5 min; p = 0.0018), reduced ICU LOS (0.1 ± 0.3 vs 1.6 ± 4.0 days; p = 0.0002), and shorter overall LOS (2.4 ± 1.1 vs 13.2 ± 6.1 days; p < 0.0001). Complications were fewer (p = 0.0022), and dietary progression improved (p = 0.0181), with a trend toward earlier sports resumption (p = 0.0545). Follow-up duration was markedly shorter in the TH group (median 109 days [IQR 70-151] vs. 1465 days [IQR 924-2390], p = 0.0041). CONCLUSION: TH is a safe, effective antireflux therapy for CDH, offering better recovery and fewer complications. Interpretation is limited by the shorter follow-up in the thoracoscopic group. Long-term randomized trials are needed to confirm these results.