Retrospective cohort analysis of current trends in the surgical management of congenital diaphragmatic eventration in children.

Background: Diaphragmatic plication is the most widely used surgical approach for treating congenital diaphragmatic eventration (CDE) in children. This study aims to assess current surgical practice for this pathology in children. Methods: Retrospective data analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021. Comparative description of the different surgical approaches and their outcomes, including robot-assisted thoracoscopic surgery (RATS). (Clinical Trials [NCT04862494][1]). Results: 112 patients, aged 12 [5 - 21] months, were operated on for CDE. Diaphragmatic plication was performed using thoracoscopy or RATS in 69 (62%) cases, postero-lateral thoracotomy (PLT) in 15 (13%), and using an abdominal approach in 28 (25%). Relief of symptoms and improvement in the diaphragmatic level on chest radiographs were obtained in 88% and 90% of the cases, respectively. We recorded 32 peri- or early postoperative complications (29%) and eight recurrences of eventration (7%), but found no correlation between these complications and the surgical approach used. Compared to other approaches, PLT multiplied the duration of intravenous analgesia by three (96 vs 36h, p<0.0001), and the length of hospital stay by two (8 vs 4d, p = 0.002). Compared to thoracoscopy, RATS provided more perioperative hepatic injuries and equivalent short-term results, but all five patients remained symptomatic and two of them experienced chest wall deformities in long-term follow-up. Conclusions: Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. RATS emerges as a promising surgical approach, but further is required to confirm that it is, at least, not inferior to thoracoscopy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of the University Hospital Center of Angers gave ethial approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04862494&atom=%2Fmedrxiv%2Fearly%2F2024%2F02%2F15%2F2024.02.15.24302855.atom