Thoracoscopic diaphragmatic plication in small infants

Diaphragmatic eventration often causes progressive dyspnea on exertion or respiratory infection in small children, especially those under 2 years of age. Diaphragmatic plication by minimally invasive surgery is evaluated for quick recovery and has been performed on small children. Methods: Nine patients ranging in age from 1 to 33 months and in weight from 3 to 12 kg were treated by thoracoscopic diaphragmatic plication. Six of them needed preoperative support from a respirator or nasal directional positive airway pressure. Three patients had congenital heart disease with right‐to‐left shunt. The operations were performed with three ports. We put the optical port at the sixth intercostal space and had enough view with artificial pneumothorax at 4 mmHg using carbon dioxide. Single‐lung ventilation was never used. The redundant diaphragm was pulled and plicated with non‐absorbable 3‐0 sutures. Results: The thoracoscopic approach was successful in all nine patients. No conversion was needed. All patients were recovered well postoperatively, except for one patient with a pneumothorax. The patients who needed respiratory support before the operation no longer required it within 8 d of surgery. Conclusion: In conclusion, we showed the feasibility of performing the thoracoscopic plication procedures on small infants. In our series, six out of nine patients were <6 kg and four of them were as young as 1 month old. We placed the optical port near the diaphragm, and this may have been a major factor in helping the surgery succeed. In conclusion, early thoracoscopic plication should be considered even for the small infants with diaphragmatic eventration.