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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Minimally invasive surgery in infants with cardiac anomalies

Meeting Abstract

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  • Christine Burgmeier - Universitätsklinikum Ulm, Allgemein-, Viszeral- und Kinderchirurgie, Ulm, Deutschland
  • Felix Schier - Universitätsklinikum Mainz, Abteilung für Kinderchirurgie, Mainz, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch576

doi: 10.3205/15dgch576, urn:nbn:de:0183-15dgch5767

Published: April 24, 2015

© 2015 Burgmeier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Introduction: Minimally invasive surgery is progressively performed in pediatric surgery, even in small infants and premature babies. Nevertheless, there is a lack of knowledge about the influence of insufflation and carbon dioxide on the cardiovascular system, especially in infants with cardiac anomalies. Our aim was to evaluate the hemodynamic effects of minimally invasive surgery in term and preterm infants with cardiac anomalies.

Material and methods: We retrospectively reviewed all term and preterm infants with cardiac anomalies undergoing minimally invasive surgery within the first six months of life. Between January 2004 until January 2013, 146 infants with cardiac anomalies underwent minimally invasive surgery in a single institution. We evaluated type of cardiac anomaly, operative procedure, operative time and insufflation pressure. We particularly focused on the hemodynamic effects and changes in the echocardiography in the postoperative course.

Results: Altogether, 131 infants underwent laparoscopic surgery and 15 infants underwent thoracoscopic procedures within the first six months of life. The most common laparoscopic procedure was laparoscopic inguinal hernia repair. Besides pyloromyotomy, repair of duodenal or intestinal atresia as well as laparoscopic pull-through procedure were performed. Thoracoscopic procedures included repair of esophageal atresia (EA) and congenital diaphragmatic hernia (CDH). Insufflation pressure varied from 8 to 15 mmHg. Cardiac anomalies ranged from persistent foramen ovale (PFO), atrium septal defect (ASD) to ventricular septal defect (VSD) and tetralogy of Fallot. 52 infants (35.6 %) had combinations of cardiac anomalies. 12 of 146 (8.2 %) had hemodynamically relevant shunting already preoperatively. In the postoperative course hemodynamic impairment was noted in three infants (2.0 %). Only one of them presented cardiorespiratory instability in the postoperative course.

Conclusion: This retrospective study demonstrates that different minimally invasive procedures can be performed safely in infants with different cardiac anomalies. However, preoperative evaluation by a firm pediatric cardiologist and a specialized anesthesiologist is mandatory to successfully perform these procedures. In the future, further prospective studies are necessary to clarify contraindications for minimally invasive surgery in this special group of patients.