Traitement chirurgical par thoracoscopie de la hernie diaphragmatique congénitale
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Résumé
Thoracoscopy was inspired by the therapy of collapsed lung at the beginning of the 20th century in the epidemic of pulmonary tuberculosis. Minimally invasive surgery is increasingly becoming the first treatment proposal for left congenital diaphragmatic hernia.
A two-year-old child was hospitalized for a congenital diaphragmatic hernia, revealed late in the neonatal period; the preoperative preparation consisted in stabilizing the child on the hemodynamic and respiratory level, he benefited surgical repair by thoracoscopy, treatment of postoperative pain like any thoracic surgery. Normal feeding was obtained in 24 hours. Diaphragmatic hernia diagnosis out of neonatal period represents a polymorphism of symptoms including strangulation, can be diagnosed at any age, the left posterolateral form is the most common form.
Thoracoscopy was indicated as a first-line treatment given the small volume of gas insufflation sufficient to create a wide operating field with a collapsed lung. Cardiorespiratory intolerance is very rare with a small pressure, with a small volume and an insufflation stop as soon as the pressure of 6 mmHg is maintained. The analysis of this case and the review of the literature showed that the absence of a thoracotomy offers a better functional result.
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